Provider Demographics
NPI:1730764242
Name:TSCHETTER, SHIRLEY F
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:F
Last Name:TSCHETTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 GALAXY WAY
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-6364
Mailing Address - Country:US
Mailing Address - Phone:541-761-9290
Mailing Address - Fax:
Practice Address - Street 1:2166 NW VINE ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-8413
Practice Address - Country:US
Practice Address - Phone:541-474-8000
Practice Address - Fax:541-474-3296
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000004233172V00000X
OR010662171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No172V00000XOther Service ProvidersCommunity Health Worker