SHANE GAMBLE (NPI# 1619580776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619580776 |
| Entity Type | Individual |
| Full Name | SHANE GAMBLE |
| Credential | RD |
| Practice Address |
913 Nw Garden Valley Blvd Roseburg OR 97471-6523 |
| Mailing Address |
1025 Nw Basco Ave Roseburg OR 97471-6164 |
| Practice Telephone | 5414401000 |
| Mailing Telephone | 7742170722 |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 133V00000X | Dietitian, Registered | 4758 | MA | Dietary & Nutritional Service Providers |
| Y | 133V00000X | Dietitian, Registered | 86058164 | Dietary & Nutritional Service Providers |
| Street Address |
913 NW GARDEN VALLEY BLVD |
| City | ROSEBURG |
| State | OR |
| Zip Code | 97471-6523 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003874546 | Roseburg Vamc | Department of Veterans Affairs (VA) Pharmacy | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2006-05-03 |
| 1114525607 | Kenny Duong | Pharmacist | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2020-10-15 |
| 1588262521 | Ayman Alholail | Pharmacist | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2020-10-12 |
| 1194332528 | Carrie Webster | Psychologist | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2020-09-29 |
| 1942811658 | Shannon O'leary | Pharmacist | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2020-08-14 |
| 1215554209 | Joseph Albrecht | Dietitian, Registered | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2020-06-25 |
| 1609402601 | Crystal Marie Leatherman | Dietitian, Registered | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6513 | 2020-03-21 |
| 1477189710 | Foua Xiong | Pharmacist | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2020-03-18 |
| 1700425741 | Leah Isip | Pharmacist | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2019-12-21 |
| 1598306060 | Anna Alexandra Jadanova | Psychologist | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2019-10-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841805660 | Rae Ann Barnes | Pharmacist | 913 Ne Garden Valley Blvd, Pharmacy, Roseburg, OR 97471 | 2020-09-09 |
| 1023651031 | Colton Phillips | Behavioral Analyst | 940 Nw Garden Valley Bvld #104, Roseburg, OR 97471 | 2019-10-22 |
| 1952884876 | Meredith Krugel Lcsw PC | Clinic/Center | 2225 Nw Stewart Parkway Ste 200, Roseburg, OR 97471 | 2018-09-07 |
| 1114456563 | Philip Kaser Family, LLC | Pharmacy | 1175 W. Harvard Avenue, Roseburg, OR 97471 | 2017-06-08 |
| 1053854208 | Icco LLC | Clinic/Center | 1740 Nw Goetz Street, Roseburg, OR 97471 | 2016-11-21 |
| 1770034589 | Evie Jepsen | Case Manager/Care Coordinator | 2700 Stewart Parkway Annex B, Suite 110, Roseburg, OR 97471 | 2016-10-17 |
| 1932551256 | Jonathan Schmidt | Licensed Practical Nurse | 913 Nm Garden Valley Blvd, Va Roseburg Medical Center, Roseburg, OR 97471 | 2016-07-11 |
| 1932580586 | Jeffrey Mark Wareham | Case Manager/Care Coordinator | 2700 Medical Loop, Annex B, Roseburg, OR 97471 | 2015-06-09 |
| 1558784215 | Ginger Jean Thibedeau | Massage Therapist | 3019 Nw Stewart Parkway, Suite 304 #183, Roseburg, OR 97471 | 2014-01-30 |
| 1427303122 | Karishma Parekh | Internal Medicine | 2460 Nw Stewart Pkwy Ste 103, Roseburg, OR 97471 | 2012-07-18 |
| Find all providers in zip 97471 | ||||
| Taxonomy Code | 133V00000X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. |
| Notes: Source: The American Dietetic Association. Becoming a Registered Dietitian – a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699709659 | Elizabeth A. Vallance | Dietitian, Registered | 913 Nw Garden Valley Blvd Bldg 71, Roseburg, OR 97470-6523 | 2006-07-10 |
| 1144834912 | Meredith Lafrance | Dietitian, Registered | 150 Ne Kenneth Ford Dr, Roseburg, OR 97470-1042 | 2020-08-31 |
| 1215554209 | Joseph Albrecht | Dietitian, Registered | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2020-06-25 |
| 1609402601 | Crystal Marie Leatherman | Dietitian, Registered | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6513 | 2020-03-21 |
| 1386127298 | Lauren Michelle Haddock | Dietitian, Registered | 2371 Ne Stephens St Ste 200, Roseburg, OR 97470-1399 | 2018-09-07 |
| 1467985515 | Shelli Willman | Dietitian, Registered | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2017-04-05 |
| 1508315045 | Erin Audiss | Dietitian, Registered | 2371 Ne Stephens St, Roseburg, OR 97470-1372 | 2016-09-26 |
| 1619349321 | Michon Kysilka | Dietitian, Registered | 913 Nw Garden Valley Blvd, Roseburg, OR 97471-6523 | 2015-10-21 |
| 1316332885 | Jill Marie Boyce | Dietitian, Registered | 2371 Ne Stephens St, Suite 200, Roseburg, OR 97470-1372 | 2015-04-01 |
| 1699179622 | Brianna Syron | Dietitian, Registered | 2371 Ne Stephens St, Suite 200, Roseburg, OR 97470-1372 | 2014-10-20 |
| Find all providers in ROSEBURG | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.