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General NPI Number Information
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NPI Number | 1538709092
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Entity Type | Individual
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Provider Name | WARREN SHADKO PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 11335 NE 122ND WAY STE 105
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City | KIRKLAND
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State | WA
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Zip | 98034-6933
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Country | US
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Telephone | 425-298-7480
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Fax |
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Provider Business Mailing Address
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Address Line | 11335 NE 122ND WAY STE 105
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City | KIRKLAND
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State | WA
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Zip | 98034-6933
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Country | US
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Telephone | 425-298-7480
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 277126
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5012834
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 836257
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61098454
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License Number State | WA
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