Provider Demographics
NPI:1003836529
Name:SHADE, ERIN D (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:D
Last Name:SHADE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MADISON ST.
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-965-1700
Mailing Address - Fax:206-965-1736
Practice Address - Street 1:1101 MADISON ST.
Practice Address - Street 2:SUITE 1500
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-965-1700
Practice Address - Fax:206-965-1736
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001488133V00000X
WAPA60072835363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA54991UOtherREGENCE BLUESHIELD