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General NPI Number Information
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NPI Number | 1821851239
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Entity Type | Organization
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Legal Business Name | SHINE PEDIATRICS, PLLC
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Dates
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Enumeration Date | 01/31/2024
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 1600 116TH AVE NE STE 304
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City | BELLEVUE
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State | WA
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Zip | 98004-3057
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Country | US
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Telephone | 225-715-5242
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Fax |
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Provider Business Mailing Address
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Address Line | 25676 SE 149TH ST
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City | ISSAQUAH
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State | WA
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Zip | 98027-8331
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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 | CO-OWNER, ARNP
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Name | STACI SWAN
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Credential | ARNP
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Telephone | 225-715-5242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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