Shasta Mandan, R.N., C.D.E.

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

R29464 Issued in ND

Practice address

1058 College Dr
New Town, ND 58763-9112

Phone

(701) 627-7931

NPI assigned

Jun 1, 2016

Last updated

Jun 1, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1386092203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 COLLEGE DR",
            "city": "NEW TOWN",
            "state": "ND",
            "postal_code": "587639112",
            "telephone_number": "701-627-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 COLLEGE DR",
            "city": "NEW TOWN",
            "state": "ND",
            "postal_code": "587639112",
            "telephone_number": "701-627-7931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDAN",
        "first_name": "SHASTA",
        "credential": "R.N., C.D.E.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "ND",
            "license": "R29464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joann K Lee, MD
• Kelcey Rae Lee, DNP, FNP-C
• Nicole Mura Lichter, APRN-CNP, PMHNP-BC
• Allison Lovcik, RDH
• Douglas Mai
• Wayne H Marmon, DPH
• Anita Louise Martin, M.D.
• Roselle Martin, B.S, L.N
• Monica Mayer, M.D.
• Frances McDonald, RN

• Diabetes Educator Registered Nurse in New Town, ND
• Providers in New Town, ND by specialty
• Diabetes Educator Registered Nurse in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.