Shannon Elizabeth Wiedeman, NP and RN
Registered Nurse, Psych/Mental Health in Enterprise, OR. Individual provider (NPI-1).
NPI number1255596607
StatusActive
Last updated in NPPESApr 5, 2016
Details
- NPI
- 1255596607
- Entity type
- Individual (NPI-1)
- Name
- Shannon Elizabeth Wiedeman
- Credential
- NP and RN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 25, 2008
- Last updated
- Apr 5, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WP0808X | Registered Nurse, Psych/Mental Health | 201043506RN | OR | Yes |
| 363LA2200X | Nurse Practitioner, Adult Health | 201050225NP | OR |
Other names
- Shannon Elizabeth Payden (Former Name)
Practice location
207 Sw 1st StEnterprise, OR 97828-1203
Phone 541-426-0801 · Fax 541-426-0802
Mailing address
207 Sw 1st StEnterprise, OR 97828-1203
Phone 541-426-4524 · Fax 541-426-3035
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