SHANNON ELIZABETH WIEDEMAN NP AND RN NPI 1255596607

NPI Information

NPI: 1255596607
Provider Name: SHANNON ELIZABETH WIEDEMAN, NP AND RN
Classification: Registered Nurse - 163WP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

Address:
207 SW 1ST ST
ENTERPRISE, OR
ZIP 97828
Phone: (541) 426-0801
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Shannon Elizabeth Wiedeman, NP AND RN is a psychiatric/mental health registered nurse in Enterprise, OR. Shannon Elizabeth Wiedeman, NP AND RN NPI is 1255596607. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

207 SW 1ST ST
ENTERPRISE, OR
ZIP 97828-203
Phone: (541) 426-0801
Fax: (541) 426-0802

The enumeration date for this NPI number is 7/25/2008 and was last updated on 4/5/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health	201050225NP	OREGON	No
2	163WP0808X	Registered Nurse	Psychiatric/Mental Health	201043506RN	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	383864	OTHER	OREGON	MEDICARE RHC
2	500641038	MEDICAID	OREGON
3	O10244476AA	OTHER	OREGON	REGENCE BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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