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General NPI Number Information
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NPI Number | 1457187635
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Entity Type | Individual
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Provider Name | SHANNON EVANS
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 143 PARK LN
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City | KIRKLAND
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State | WA
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Zip | 98033-6172
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Country | US
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Telephone | 206-604-0676
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Fax |
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Provider Business Mailing Address
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Address Line | 3310 211TH AVE NE
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City | SAMMAMISH
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State | WA
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Zip | 98074-6329
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Country | US
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Telephone | 206-604-0676
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC61548966
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License Number State | WA
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