Provider Demographics
NPI:1245319169
Name:MONTEGNA, SHAE NOELLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHAE
Middle Name:NOELLE
Last Name:MONTEGNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SHAE
Other - Middle Name:NOELLE
Other - Last Name:TANGREDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:18 NW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4175
Mailing Address - Country:US
Mailing Address - Phone:360-952-4457
Mailing Address - Fax:360-828-7409
Practice Address - Street 1:650 N DEVINE RD STE B
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6979
Practice Address - Country:US
Practice Address - Phone:360-952-4457
Practice Address - Fax:360-828-7409
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR PA00727363AM0700X
ORPA00727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003546Medicaid
ORP01252763OtherRR MEDICARE (PH&S)
OR500606847Medicaid
OR500606847Medicaid
ORR171342Medicare PIN
ORR175044Medicare PIN
WAG8942984Medicare PIN
ORR178051Medicare PIN
ORR171340Medicare PIN
ORP01252763OtherRR MEDICARE (PH&S)
ORR178999Medicare PIN
ORR171341Medicare PIN
ORR178052Medicare PIN