Vivian June Shaw, CRM

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

20-CRM-179 Issued in OR

Practice address

46314 Timine Way
Pendleton, OR 97801-9417

Phone

(541) 966-9830

Fax

(541) 240-8754

NPI assigned

Jul 31, 2020

Last updated

Jul 31, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Vivian June Sohappy Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1205446663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978010160",
            "telephone_number": "541-966-9830",
            "fax_number": "541-240-8754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46314 TIMINE WAY",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978019417",
            "telephone_number": "541-966-9830",
            "fax_number": "541-240-8754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "VIVIAN",
        "middle_name": "JUNE",
        "credential": "CRM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-31",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "OR",
            "license": "20-CRM-179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "LindaHettinga@yellowhawk.org",
            "affiliation": "N",
            "endpointDescription": "work email",
            "address_1": "46314 Timine Way",
            "city": "Pendleton",
            "state": "OR",
            "country_code": "US",
            "postal_code": "978019417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "VIVIAN",
            "last_name": "SOHAPPY",
            "middle_name": "JUNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Prevention Professional in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Prevention Professional in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.