IndividualActive
Vivian Shaw, CRM
NPI 1205446663 · Prevention Professional · Pendleton, OR
Provider details
- NPI number
- 1205446663
- Entity type
- Individual
- Primary specialty
- Prevention ProfessionalOther Service Providers
- Credential
- CRM
- Sex
- Male
- Sole proprietor
- No
- License
- 20-CRM-179 (OR)
Specialties & taxonomies
Other Service Providers
Practice location
46314 Timine Way
Pendleton, OR 97801-9417
Phone: (541) 966-9830
Fax: (541) 240-8754
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 160
Pendleton, OR 97801-0160
Registry dates
- Enumerated
- 2020-07-31
- Last updated
- 2020-07-31
- Certified
- 2020-07-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.