Healthcare Provider Details

I. General information

NPI: 1730298555
Provider Name (Legal Business Name): ANN M SHAHAN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

IV. Provider business mailing address

26507 41ST AVE E
SPANAWAY WA
98387-9424
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1672
  • Fax: 253-489-4064
Mailing address:
  • Phone: 253-583-1672
  • Fax: 253-489-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: