MR. SHANE A. VATH (NPI# 1912067760) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912067760 |
| Entity Type | Individual |
| Full Name | MR. SHANE A. VATH |
| Credential | SHANE VATH, DSC PT |
| Practice Address |
100 Brewster Blvd Naval Hospital Camp Lejeune NC 28547-2538 |
| Practice Telephone | 9104504159 |
| Practice Fax Number | 9104504194 |
| Mailing Telephone | 9104504159 |
| Mailing Fax Number | 9104504194 |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2011-08-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171000000X | Military Health Care Provider | 2305005892 | VA | Other Service Providers |
| Street Address |
100 BREWSTER BLVD NAVAL HOSPITAL |
| City | CAMP LEJEUNE |
| State | NC |
| Zip Code | 28547-2538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588668982 | Pierce Overman | Family Medicine | 100 Brewster Blvd, Naval Hospital, Camp Lejeune, NC 28547-2538 | 2005-06-13 |
| 1275146417 | Kristi Lynn Dixon | Nurse Practitioner | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-08-27 |
| 1841802253 | Konstance Mackie | Nurse Practitioner | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-08-18 |
| 1003425117 | Jeremy Moore | Licensed Practical Nurse | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-07-24 |
| 1801404546 | Erika Merite Papenfuss | Nurse Anesthetist, Certified Registered | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-07-20 |
| 1306454244 | Devon Nicole Dan | Nurse Anesthetist, Certified Registered | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-07-16 |
| 1851918957 | Uriah Nmn Paul | Nurse Anesthetist, Certified Registered | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-07-06 |
| 1447876529 | Leslee Lynne Smith | Speech-Language Pathologist | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-06-24 |
| 1356965727 | Haleigh Leister | Specialist/Technologist | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-06-02 |
| 1407482045 | Shajaylyn Lee-combs | Student in an Organized Health Care Education/Training Program | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2020-03-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558906032 | Abigail Deemer | Physician Assistant | L Street, Bldg Hp-416, Camp Lejeune, NC 28547 | 2019-11-08 |
| 1407406267 | Michelle Ferricher | Nurse Practitioner | Naval Medical Center Pediatric Clinic, Nh-200 Recovery Way, Camp Lejeune, NC 28547 | 2019-09-13 |
| 1215595566 | Kayla L Torrez Chang | General Practice | Mcmh Fc 308, Hm Smith Boulevard, Camp Lejeune, NC 28547 | 2019-06-02 |
| 1699338442 | Amanda Leigh Jepsen | Military Health Care Provider | Naval Medical Center; 100 Brewster Blvd, Camp Lejeune, NC 28547 | 2019-04-17 |
| 1306336995 | Erik Reid King | Physician Assistant | F Street Bldg. Hp206, Camp Lejeune, NC 28547 | 2018-05-18 |
| 1114434032 | David John Mcdermott | Specialist/Technologist | Bldg. H1 Julian C Smith Rd., Camp Lejuene, NC 28547 | 2017-12-30 |
| 1235678434 | Nicolle Elizabeth Johnson | Occupational Therapist | 180 Hospital Corps Blvd., Camp Lejeune, NC 28547 | 2017-02-21 |
| 1427435585 | Naval Medical Center Camp Lejeune | Military/U.S. Coast Guard Pharmacy | Stone St. Extention, Bldg Nh200, Camp Lejeune, NC 28547 | 2015-04-28 |
| 1043634173 | Garrett Michael Wren | Obstetrics & Gynecology | Naval Medical Center, 100 Brewster Blvd, Camp Lejeune, NC 28547 | 2014-02-10 |
| 1245662436 | Samuel Maluil | Internal Medicine | Bldg 124 Wallace Creek, Camp Lejeunce, NC 28547 | 2013-07-30 |
| Find all providers in zip 28547 | ||||
| Taxonomy Code | 171000000X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |
| Notes: [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699338442 | Amanda Leigh Jepsen | Military Health Care Provider | Naval Medical Center; 100 Brewster Blvd, Camp Lejeune, NC 28547 | 2019-04-17 |
| 1326296641 | Scott Durham Mitcham | Military Health Care Provider | Command Drive, Building 328, Camp Lejeune, NC 28542 | 2008-08-28 |
| 1588284145 | Brett Michael Frazier | Military Health Care Provider | Naval Medical Center Camp Lejeune, 100 Brewster Boulevard, Camp Lejeune, NC 28547 | 2020-04-23 |
| 1467089565 | Philip Daniel Brewer | Military Health Care Provider | Naval Medical Center, 100 Brewster Blvd., Camp Lejeune, NC 28547 | 2020-03-26 |
| 1619523594 | Sarah Michele Anderson | Military Health Care Provider | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2019-08-15 |
| 1588122667 | Nathan Meier | Military Health Care Provider | Naval Medical Center, 100 Brewster Blvd., Camp Lejeune, NC 28547-2538 | 2019-03-07 |
| 1508354820 | Brooke Danielle Streett | Military Health Care Provider | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2018-04-23 |
| 1780171173 | Emily Makhlouf | Military Health Care Provider | Naval Hospital Camp Lejeune, 100 Brewster Blvd, Camp Lejeune, NC 28547 | 2018-04-20 |
| 1841719390 | Kyle Hagan | Military Health Care Provider | 100 Brewster Blvd, Camp Lejeune, NC 28547-2575 | 2017-09-15 |
| 1518348119 | Alexander Eye | Military Health Care Provider | Naval Medical Ctr, 100 Brewster Blvd, Camp Lejeune, NC 28460 | 2015-06-09 |
| Find all providers in CAMP LEJEUNE | ||||
| City | CAMP LEJEUNE |
| Zip Code | 28547 |
Please comment or provide details below to improve the information on MR. SHANE A. VATH.
| 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.