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1255116752 NPI number — SHELISSIA MARIE PINCENTI

NPI Number: 1255116752
Health Care Provider/Practitioner: SHELISSIA MARIE PINCENTI

Information about “1255116752” NPI (SHELISSIA MARIE PINCENTI) exists in 1255116752 in HTML format HTML  |  1255116752 in plain Text format TXT  |  1255116752 in PDF (Portable Document Format) PDF  |  1255116752 in an XML format XML  formats.

NPI Number : 1255116752 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255116752",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PINCENTI",
    "FirstName": "SHELISSIA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PINCENTI",
    "OtherFirstName": "SHELISSIA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CORNFORD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 1710",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PRINEVILLE",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97754-0880",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-202-9775",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1059 NW MADRAS HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PRINEVILLE",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97754-1416",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-233-3365",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/31/2023",
    "LastUpdateDate": "10/09/2023",
    "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": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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