Healthcare Provider Details

I. General information

NPI: 1750758504
Provider Name (Legal Business Name): ERIC SHIREY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 5TH AVE MAILSTOP KCJ-PH-0600
SEATTLE WA
98104-2332
US

IV. Provider business mailing address

500 5TH AVE MAILSTOP KCJ-PH-0600
SEATTLE WA
98104-2332
US

V. Phone/Fax

Practice location:
  • Phone: 206-477-2293
  • Fax: 206-296-0579
Mailing address:
  • Phone: 206-477-2293
  • Fax: 206-296-0579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN00099528
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: