Healthcare Provider Details

I. General information

NPI: 1033928049
Provider Name (Legal Business Name): DORI LYNN SHANE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12826 NE 203RD PL
BOTHELL WA
98011-7613
US

IV. Provider business mailing address

12826 NE 203RD PL
BOTHELL WA
98011-7613
US

V. Phone/Fax

Practice location:
  • Phone: 425-745-4345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN00101355
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: