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General NPI Number Information
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NPI Number | 1699172478
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Entity Type | Individual
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Provider Name | KAREN SHIVELY
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Gender | Female
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Dates
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Enumeration Date | 11/22/2014
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Last Update Date | 06/21/2019
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Provider Practice Location Address
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Address Line | 202 N DIVISION ST STE 304
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City | AUBURN
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State | WA
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Zip | 98001-4939
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Country | US
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Telephone | 253-939-9400
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Fax | 253-735-8697
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Provider Business Mailing Address
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Address Line | 3209 S 23RD ST STE 340
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City | TACOMA
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State | WA
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Zip | 98405-1602
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP60527158
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License Number State | WA
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