Provider Demographics
NPI:1235315706
Name:SHANHOLTZER, DAVID B (NP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:SHANHOLTZER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:12800 BOTHELL EVERETT HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-316-5150
Practice Address - Fax:425-316-5153
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60538059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235315706OtherOPTIMA/SENTARA HEALTH
VA1235315706Medicaid
VA1235315706OtherTRICARE/HEALTHNET
VA1235315706OtherTRICARE/HEALTHNET