Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AP60948494 | WA |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60948494 | WA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NP0234 | GU |
NPI | 1144782095 |
---|---|
Provider Name | Shicara Irvin |
First Address | Seattle, WA 98101-3165 |
Second Address | Tamuning, GU 96913-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 08/12/2021 |