Provider Demographics
NPI:1043487069
Name:SHAW, DEEANNE RENEE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DEEANNE
Middle Name:RENEE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7719 SWANSON DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6439
Mailing Address - Country:US
Mailing Address - Phone:253-377-4417
Mailing Address - Fax:
Practice Address - Street 1:7719 SWANSON DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6439
Practice Address - Country:US
Practice Address - Phone:253-377-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025200171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor