MRS. SHELLY JEAN DUBISAR (NPI# 1972010874) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972010874 |
| Entity Type | Individual |
| Full Name | MRS. SHELLY JEAN DUBISAR |
| Practice Address |
1975 Mcpherson St Ste 2 North Bend OR 97459-3482 |
| Practice Telephone | 5417512549 |
| Practice Fax Number | 5417512660 |
| Mailing Telephone | 5417512549 |
| Mailing Fax Number | 5417512660 |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2018-01-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | Other Service Providers |
| Street Address |
1975 MCPHERSON ST STE 2 |
| City | NORTH BEND |
| State | OR |
| Zip Code | 97459-3482 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346544277 | Ariana Renee Mofran | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2011-01-06 |
| 1558878371 | Lashaunia Ebony Pross | Peer Specialist | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2018-01-02 |
| 1922536978 | Robert James Cooprider | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2017-06-02 |
| 1942748728 | Jamie Ledoux | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2017-02-01 |
| 1831633676 | Keeley Harris | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2016-12-13 |
| 1073056859 | Jennifer Marie Vonfelden | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2016-11-28 |
| 1518319805 | Heather Lynn Hernandez | Peer Specialist | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2016-07-11 |
| 1245685544 | Jennifer Gilroy | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2016-04-25 |
| 1841669140 | Daniel Emmett | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2015-09-17 |
| 1386011732 | Shannon Hamlin | Counselor | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2015-09-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568002749 | Ya-chi Claire Chang | Nurse Practitioner | 1229 1890 Waite St #1, North Bend, OR 97459 | 2020-01-15 |
| 1629573977 | Heather M Coates | Counselor | 400 Virginia Ave Ste 100, North Bend, OR 97459 | 2018-03-28 |
| 1205257219 | Melissa Sperry | Health Educator | 510 Lockhart Street, North Bend, OR 97459 | 2013-12-17 |
| 1265862627 | Elizabeth Sylvester | Counselor | 1592 Monroe Street, North Bend, OR 97459 | 2013-11-22 |
| 1124370291 | Brian Noble Thompson | Pharmacist | 3411 Broadway St., North Bend, OR 97459 | 2012-10-12 |
| 1295081230 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3411 Broadway St, North Bend, OR 97459 | 2012-07-27 |
| 1366728370 | Melissa Jean Kovach | Occupational Therapy Assistant | 3959 Sheridan Ave., North Bend, OR 97459 | 2011-10-24 |
| 1295045052 | Mary Kay Weikel | Massage Therapist | 3229 Broadway St Suite G Serenity Therapy Center, North Bend, OR 97459 | 2010-10-14 |
| 1902080013 | Anthony Eugene Baldacci | Registered Nurse | 1836 Meade Street, North Bend, OR 97459 | 2007-12-26 |
| 1952595340 | Inland Point Senior Estates Jv LLC | Clinic/Center | 2265 Inland Drive, North Bend, OR 97459 | 2007-08-29 |
| Find all providers in zip 97459 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326600230 | Olivia Funk | Peer Specialist | 1960 Sherman Ave, North Bend, OR 97459-3420 | 2019-07-01 |
| 1740768720 | Aaron Timothy Williams | Peer Specialist | 1913 Meade St, North Bend, OR 97459-3432 | 2018-08-01 |
| 1558878371 | Lashaunia Ebony Pross | Peer Specialist | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2018-01-02 |
| 1013422013 | Max Michael Murphy | Peer Specialist | 1913 Meade St, North Bend, OR 97459-3432 | 2017-12-12 |
| 1043723273 | Penny Peters | Peer Specialist | 1975 Mcpherson, Ste 2, North Bend, OR 97459 | 2017-11-09 |
| 1942725270 | Jamella Ann Weeks | Peer Specialist | 1913 Meade St, North Bend, OR 97459-3432 | 2017-08-08 |
| 1134657638 | Kaiwi Ruth Valentine Murdock | Peer Specialist | 1913 Meade St, North Bend, OR 97459-3432 | 2017-05-27 |
| 1750817193 | Tianna Finn | Peer Specialist | 1913 Meade Street, North Bend, OR 97459 | 2017-05-04 |
| 1528517281 | Paige Loreley Wethington | Peer Specialist | 1913 Meade St, North Bend, OR 97459-3432 | 2016-09-22 |
| 1518319805 | Heather Lynn Hernandez | Peer Specialist | 1975 Mcpherson St Ste 2, North Bend, OR 97459-3482 | 2016-07-11 |
| Find all providers in NORTH BEND | ||||
| City | NORTH BEND |
| Zip Code | 97459 |
Please comment or provide details below to improve the information on MRS. SHELLY JEAN DUBISAR.
| 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.