Healthcare Provider Details

I. General information

NPI: 1043632821
Provider Name (Legal Business Name): WASHINGTON NUCLEAR MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N DIVISION ST PLAZA ONE
AUBURN WA
98001-4939
US

IV. Provider business mailing address

16243 25TH AVE SW
BURIEN WA
98166-2611
US

V. Phone/Fax

Practice location:
  • Phone: 253-333-2574
  • Fax:
Mailing address:
  • Phone: 206-243-1315
  • Fax: 253-288-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD00024085
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberMD00024085
License Number StateWA

VIII. Authorized Official

Name: ANDREW THOMAS SHIELDS
Title or Position: OWNER
Credential: MD
Phone: 206-963-5339