Healthcare Provider Details

I. General information

NPI: 1700236833
Provider Name (Legal Business Name): JENNIFER L SHONK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 200
PULLMAN WA
99163-5537
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 200
PULLMAN WA
99163-5537
US

V. Phone/Fax

Practice location:
  • Phone: 509-336-7720
  • Fax:
Mailing address:
  • Phone: 509-336-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61631915
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: