Provider Demographics
NPI:1073771879
Name:BOARDMAN, SHANDA J
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:J
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MCLOUGHLIN BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2564
Mailing Address - Country:US
Mailing Address - Phone:360-696-2561
Mailing Address - Fax:
Practice Address - Street 1:400 E 33RD ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2238
Practice Address - Country:US
Practice Address - Phone:360-696-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist