Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP60801930 | WA |
NPI | 1003320383 |
---|---|
Provider Name | Mrs. Shannon Leigh Rose |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98104-2433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2017 |
Last Update Date | 16/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003320383 | (05) | WA |