Active NPI
Shannon Gillette
- Registered Nurse
- Roseburg, OR
National Provider Identifier
1699560219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 10023310
- Practice address
- 3099 NE Diamond Lake Blvd
Roseburg, OR 97470-3655 - Phone
- (541) 673-3469
- NPI assigned
- Apr 14, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 10023310 | OR | Primary |
Addresses
Primary practice location
3099 NE Diamond Lake Blvd
Roseburg, OR 97470-3655
Mailing address
PO Box 1121
Roseburg, OR 97470-0254
Phone (541) 672-2691
Other names 1
- Shannon Shue & Holtzclaw
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10023310 | OR | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1744588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744588800000",
"number": "1699560219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1121",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974700254",
"telephone_number": "541-672-2691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3099 NE DIAMOND LAKE BLVD",
"city": "ROSEBURG",
"state": "OR",
"postal_code": "974703655",
"telephone_number": "541-673-3469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLETTE",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-14",
"last_updated": "2025-04-14",
"certification_date": "2025-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "10023310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "SHUE & HOLTZCLAW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Roseburg, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.