Healthcare Provider Details

I. General information

NPI: 1043511181
Provider Name (Legal Business Name): SHAYNE SUMMERS YOCUM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

325 9TH AVE
SEATTLE WA
98104-2499
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-3347
  • Fax: 206-744-9331
Mailing address:
  • Phone: 206-744-3347
  • Fax: 206-744-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60265340
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: