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1104598697 NPI number — SHANNON ISABELLE VAJRETTI QMHA

NPI Number: 1104598697
Health Care Provider/Practitioner: SHANNON ISABELLE VAJRETTI QMHA

Information about “1104598697” NPI (SHANNON ISABELLE VAJRETTI QMHA) exists in 1104598697 in HTML format HTML  |  1104598697 in plain Text format TXT  |  1104598697 in PDF (Portable Document Format) PDF  |  1104598697 in an XML format XML  formats.

NPI Number : 1104598697 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104598697",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VAJRETTI",
    "FirstName": "SHANNON",
    "MiddleName": "ISABELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "QMHA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5755 RED LEAF DR S APT 110",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALEM",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97306-3019",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "408-529-3487",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "182 SW ACADEMY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97338-1996",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-623-9289",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/02/2021",
    "LastUpdateDate": "10/28/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "171M00000X",
        "TaxonomyName": "Case Manager/Care Coordinator",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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