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General NPI Number Information
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NPI Number | 1023598000
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Entity Type | Individual
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Provider Name | JESSICA SHDO
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Gender | Female
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Dates
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Enumeration Date | 08/18/2018
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Last Update Date | 08/18/2018
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Provider Practice Location Address
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Address Line | 13718 100TH AVE NE
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City | KIRKLAND
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State | WA
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Zip | 98034-5216
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Country | US
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Telephone | 425-814-4888
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Fax |
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Provider Business Mailing Address
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Address Line | 16510 187TH AVE NE
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City | WOODINVILLE
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State | WA
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Zip | 98072-9187
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Country | US
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Telephone | 206-491-7171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60889442
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License Number State | WA
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