Healthcare Provider Details

I. General information

NPI: 1053307926
Provider Name (Legal Business Name): SHAWNA OLSON SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 SE 240TH ST STE 201
KENT WA
98031-5124
US

IV. Provider business mailing address

10024 SE 240TH ST STE 201
KENT WA
98031-5124
US

V. Phone/Fax

Practice location:
  • Phone: 253-859-2273
  • Fax: 253-850-8894
Mailing address:
  • Phone: 253-859-2273
  • Fax: 253-850-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00157415
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006893
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006893
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: