Provider Demographics
NPI:1457575102
Name:PIEDIMONTE, SHAYNA DAWN (MSN, RN, FNP)
Entity Type:Individual
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First Name:SHAYNA
Middle Name:DAWN
Last Name:PIEDIMONTE
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Gender:F
Credentials:MSN, RN, FNP
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Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:ARCHIE
Mailing Address - State:MO
Mailing Address - Zip Code:64725-0046
Mailing Address - Country:US
Mailing Address - Phone:816-430-5777
Mailing Address - Fax:816-430-5219
Practice Address - Street 1:709 E PINE
Practice Address - Street 2:
Practice Address - City:ARCHIE
Practice Address - State:MO
Practice Address - Zip Code:64725
Practice Address - Country:US
Practice Address - Phone:816-430-5777
Practice Address - Fax:816-430-5219
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2000163224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268522Medicare Oscar/Certification
MO7060000Medicare PIN