Provider Demographics
NPI:1154321453
Name:RICHERT, SHAUNA M (MD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:M
Last Name:RICHERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:JOYCE MCLAIN
Other - Last Name:RICHERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:304 W BAY DR NW
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4958
Mailing Address - Country:US
Mailing Address - Phone:360-413-8760
Mailing Address - Fax:360-413-8839
Practice Address - Street 1:304 W BAY DR NW
Practice Address - Street 2:SUITE 301
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4958
Practice Address - Country:US
Practice Address - Phone:360-413-8760
Practice Address - Fax:360-413-8839
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035844207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8221830Medicaid
WAGAB20354OtherMEDICARE
WAAB20354Medicare ID - Type Unspecified
WAGAB20354OtherMEDICARE