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NPI Code Detail

MEDICARE: MRS. SHANTA MARIE FRISBEE BSW, CADC

MEDICARE: MRS. SHANTA MARIE FRISBEE BSW, CADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1790910230
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANTA MARIE FRISBEE BSW, CADC
Provider Business Mailing Address
First Line : 627 N EVANS ST
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-3923
Country : US
Telephone Number : 503-539-9259
Fax Number :
Provider Business Practice Location Address
First Line : 1525 SW SHIRLEY ANN DR
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-7665
Country : US
Telephone Number : 503-472-4055
Fax Number : 503-472-9999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2009
Last Update Date : 05/28/2009

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