Provider Demographics
NPI:1174628838
Name:SHAW, JANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE DEPT 358
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-8004
Mailing Address - Country:US
Mailing Address - Phone:360-729-1412
Mailing Address - Fax:360-729-3025
Practice Address - Street 1:4280 MERIDIAN ST STE 110
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6464
Practice Address - Country:US
Practice Address - Phone:360-788-7733
Practice Address - Fax:360-676-7471
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1174628838OtherNPI
WAMD00026941OtherWASHINGTON STATE LICENSE #
WA8124661Medicaid
WAF38375Medicare UPIN
WAAB08983Medicare ID - Type Unspecified