Provider Demographics
NPI:1083056576
Name:FOX, SHAWNETTE D (CD)
Entity Type:Individual
Prefix:
First Name:SHAWNETTE
Middle Name:D
Last Name:FOX
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SW 4TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2228
Mailing Address - Country:US
Mailing Address - Phone:425-572-0681
Mailing Address - Fax:
Practice Address - Street 1:808 SW 4TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2228
Practice Address - Country:US
Practice Address - Phone:425-572-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603012880374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula