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1659754810 NPI number — SHANNON LEIAMBRE STAMPER RD, CSP, LD

NPI Number: 1659754810
Health Care Provider/Practitioner: SHANNON LEIAMBRE STAMPER RD, CSP, LD

Information about “1659754810” NPI (SHANNON LEIAMBRE STAMPER RD, CSP, LD) exists in 1659754810 in HTML format HTML  |  1659754810 in plain Text format TXT  |  1659754810 in PDF (Portable Document Format) PDF  |  1659754810 in an XML format XML  formats.

NPI Number : 1659754810 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659754810",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STAMPER",
    "FirstName": "SHANNON",
    "MiddleName": "LEIAMBRE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RD, CSP, LD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MORGAN",
    "OtherFirstName": "SHANNON",
    "OtherMiddleName": "LEIAMBRE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RD, CSP, LD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "610 W HAYS ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOISE",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83702",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-381-7092",
    "MailingAddressFaxNumber": "208-381-7071",
    "FirstLinePracticeLocationAddress": "610 W HAYS ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BOISE",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-381-7092",
    "PracticeLocationAddressFaxNumber": "208-381-7071",
    "EnumerationDate": "07/07/2015",
    "LastUpdateDate": "07/25/2019",
    "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": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "D-874",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "133VN1004X",
          "TaxonomyName": "Pediatric Nutrition Registered Dietitian",
          "LicenseNumber": "D-874",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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