Provider Demographics
NPI:1093382889
Name:UNRUE, DEBORAH SHANNON (RN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SHANNON
Last Name:UNRUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:SHANNON
Other - Last Name:DAUGHTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22026 20TH AVE SE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4449
Mailing Address - Country:US
Mailing Address - Phone:425-984-0788
Mailing Address - Fax:
Practice Address - Street 1:22026 20TH AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4449
Practice Address - Country:US
Practice Address - Phone:425-984-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60868273163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse