Healthcare Provider Details

I. General information

NPI: 1790785764
Provider Name (Legal Business Name): SHAUNA R WEATHERBY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MARTIN LUTHER KING JR WAY STE 104
TACOMA WA
98405-4250
US

IV. Provider business mailing address

314 MARTIN LUTHER KING JR WAY STE 104
TACOMA WA
98405-4250
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-5572
  • Fax: 253-272-5699
Mailing address:
  • Phone: 253-272-5572
  • Fax: 253-272-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP0001461
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: