Shannon Elizabeth Wiedeman, NP AND RN

Primary specialty

Psychiatric/Mental Health Registered NurseTaxonomy code 163WP0808X

License

201043506RN Issued in OR

Practice address

207 SW 1St St
Enterprise, OR 97828-1203

Phone

(541) 426-0801

Fax

(541) 426-0802

NPI assigned

Jul 25, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Shannon Elizabeth Payden Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Center for Pain P a

  • Specialist
  • Pinehurst, NC
  • NPI 1760413355
  NPD

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

{
    "created_epoch": "1216944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1255596607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 SW 1ST ST",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978281203",
            "telephone_number": "541-426-4524",
            "fax_number": "541-426-3035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 SW 1ST ST",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978281203",
            "telephone_number": "541-426-0801",
            "fax_number": "541-426-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEMAN",
        "first_name": "SHANNON",
        "middle_name": "ELIZABETH",
        "credential": "NP  AND   RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-25",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "201050225NP",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201043506RN",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500641038",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE CROSS BLUE SHIELD",
            "identifier": "O10244476AA",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RHC",
            "identifier": "383864",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "PAYDEN",
            "middle_name": "ELIZABETH",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Judith A. Wandschneider, LCSW
• William C Weisz
• Katie L Weller, CFNP
• Nicholas Bennett West, MD
• Bonnie Leigh Wickwire, D.C. / N.D.
• Jason Wilcox
• Winding Waters Clinic PC
• Winding Waters Medical Clinic
• Winding Waters Medical Clinic
• Winding Waters Medical Clinic

• Psychiatric/Mental Health Registered Nurse in Enterprise, OR
• Providers in Enterprise, OR by specialty
• Psychiatric/Mental Health Registered Nurse in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; 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.