Healthcare Provider Details

I. General information

NPI: 1891476198
Provider Name (Legal Business Name): SHAUN DAVID DYRENG RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

2032 NE 177TH ST
SHORELINE WA
98155-5237
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3000
  • Fax:
Mailing address:
  • Phone: 206-696-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number61056586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: