Healthcare Provider Details

I. General information

NPI: 1023392974
Provider Name (Legal Business Name): SHAWN VIOLET FERGUSON DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14810 15TH AVE NE
SHORELINE WA
98155-7126
US

IV. Provider business mailing address

14810 15TH AVE NE
SHORELINE WA
98155-7126
US

V. Phone/Fax

Practice location:
  • Phone: 206-204-3366
  • Fax:
Mailing address:
  • Phone: 206-204-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVT00007361
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: