Provider Demographics
NPI:1164778106
Name:TABER, SHAWN M (RN CCM)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:M
Last Name:TABER
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51621 N DEMOSS RD
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-5177
Mailing Address - Country:US
Mailing Address - Phone:509-851-8707
Mailing Address - Fax:509-588-3532
Practice Address - Street 1:51621 N DEMOSS RD
Practice Address - Street 2:
Practice Address - City:BENTON CITY
Practice Address - State:WA
Practice Address - Zip Code:99320-5177
Practice Address - Country:US
Practice Address - Phone:509-851-8707
Practice Address - Fax:509-588-3532
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARM00110622163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management