1932589124 NPI number — ROXANNE ELAINE SHAW REGISTERED NURSE

Table of content: ROXANNE ELAINE SHAW REGISTERED NURSE (NPI 1932589124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932589124 NPI number — ROXANNE ELAINE SHAW REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
ROXANNE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMER
Provider Other First Name:
ROXANNE
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932589124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100
Provider Second Line Business Mailing Address:
LINN COUNTY PUBLIC HEALTH SERVICES
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97321-0031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-967-3888
Provider Business Mailing Address Fax Number:
541-924-6911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 PACIFIC BLVD SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97321-5075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-967-3888
Provider Business Practice Location Address Fax Number:
541-924-6911
Provider Enumeration Date:
06/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  201501521RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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