Fabian James Quenelle

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

23-CRM-1828 Issued in OR

Practice address

1011 Commercial St NE
Salem, OR 97301-1049

Phone

(503) 983-9900

NPI assigned

Apr 3, 2023

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

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": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680480000000",
    "number": "1760187322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 COMMERCIAL ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 COMMERCIAL ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011049",
            "telephone_number": "503-983-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUENELLE",
        "first_name": "FABIAN",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-03",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OR",
            "license": "23-CRM-1828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://CTGR.netalytics-cloud.com/Methasoft.Net.Tribes.Grand.Ronde",
            "affiliation": "N",
            "endpointDescription": "Methasoft",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "1011 Commercial St NE",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973011049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Peer Specialist in Salem, OR
• Providers in Salem, OR by specialty
• Peer Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2023; 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.