Healthcare Provider Details

I. General information

NPI: 1114495157
Provider Name (Legal Business Name): DINA MARIE SHAUGHNESSY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 W 8TH AVE
SPOKANE WA
99204-2506
US

IV. Provider business mailing address

17703 E 6TH AVE
SPOKANE VALLEY WA
99016-9758
US

V. Phone/Fax

Practice location:
  • Phone: 509-324-1568
  • Fax: 509-327-0163
Mailing address:
  • Phone: 208-964-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60914158
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP60914158
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60914158
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60914158
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: