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General NPI Number Information
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NPI Number | 1568059384
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Entity Type | Individual
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Provider Name | SHAWN OVERBY
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Gender | Male
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 105 N 182ND ST
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City | SHORELINE
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State | WA
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Zip | 98133-4308
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Country | US
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Telephone | 206-799-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 9930 EVERGREEN WAY STE Z150
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City | EVERETT
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State | WA
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Zip | 98204-3889
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Country | US
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Telephone | 425-347-5121
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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 | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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