Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD00039754 | WA |
N | 207PE0004X | Emergency Medical Services | MD22181 | OR |
NPI | 1093938433 |
---|---|
Provider Name | Marian C Shinobu |
First Address | Seattle, WA 98124-1584 |
Second Address | Tacoma, WA 98405-4265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130620 | L & I (01) | WA |
8289845 | (05) | WA |
F73103 | (02) | WA |