MEDICARE: SHAWN M VAN DINGENEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1912547613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN M VAN DINGENEN

Provider Business Mailing Address
First Line	:	3011 E COLUMBIA AVE APT 4
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-2342
Country	:	US
Telephone Number	:	509-862-9563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3209 S DEARBORN LN
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-1535
Country	:	US
Telephone Number	:	509-862-9563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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Directions to “ SHAWN M VAN DINGENEN ” Practice Location

Language	Start Address	Practice Location

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