License holder summary

SHANELLE DEANN MICKELBERRY is a Board Of Medicine licensed to practice in Idaho. The address on file for SHANELLE DEANN MICKELBERRY is 9800 SE MILL ST PORTLAND OR 97216. This licensed professional license is not current. The license was granted 11/04/2005 and expired on 11/11/2005.

Idaho

Division of Occupational and Professional Licenses

SHANELLE DEANN MICKELBERRY
Board Of Medicine
License number
PAT-468
Date granted
11/04/2005
Date expires
11/11/2005
Class
Board Of Medicine
Status
Expired
Address
9800 SE MILL ST PORTLAND OR 97216
idaholicensing.com
ID 48354049
LAST UPDATED 2024-03-17 08:20:53 UTC

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