Healthcare Provider Details

I. General information

NPI: 1720562549
Provider Name (Legal Business Name): SHANTEL BEUA CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3629 S D ST
TACOMA WA
98418-6813
US

IV. Provider business mailing address

3629 S D ST
TACOMA WA
98418-6813
US

V. Phone/Fax

Practice location:
  • Phone: 253-798-6579
  • Fax: 253-798-2935
Mailing address:
  • Phone: 253-798-6579
  • Fax: 253-798-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: