Healthcare Provider Details

I. General information

NPI: 1427324045
Provider Name (Legal Business Name): CATHERINE YVONNE SHULL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 05/29/2024
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N LAVENTURE RD
MOUNT VERNON WA
98273-2766
US

IV. Provider business mailing address

1400 N LAVENTURE RD
MOUNT VERNON WA
98273-2766
US

V. Phone/Fax

Practice location:
  • Phone: 360-542-8900
  • Fax: 360-542-8166
Mailing address:
  • Phone: 360-542-8900
  • Fax: 360-542-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60737311
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: