Provider Demographics
NPI:1992915037
Name:WILEY, SHEILA M (LMP)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:M
Last Name:WILEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7817
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-0978
Mailing Address - Country:US
Mailing Address - Phone:360-897-1162
Mailing Address - Fax:360-897-1196
Practice Address - Street 1:22430 CEDARVIEW DR E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7532
Practice Address - Country:US
Practice Address - Phone:360-897-1162
Practice Address - Fax:360-897-1196
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00011144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist