Provider Demographics
NPI:1053307926
Name:SMITH, SHAWNA OLSON (ARNP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:OLSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 PACIFIC HWY E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1148
Mailing Address - Country:US
Mailing Address - Phone:253-382-6300
Mailing Address - Fax:253-382-6301
Practice Address - Street 1:3700 PACIFIC HWY E
Practice Address - Street 2:SUITE 100
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1148
Practice Address - Country:US
Practice Address - Phone:253-382-6300
Practice Address - Fax:253-382-6301
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00157415163W00000X
WAAP30006893363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00281594OtherRR MEDICARE
WA9643818Medicaid
WAP00281594OtherRR MEDICARE
WA9643818Medicaid