Provider Demographics
NPI:1245407634
Name:TRELEASE, SHANNON C (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:TRELEASE
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 1:209 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4267
Mailing Address - Country:US
Mailing Address - Phone:253-596-3300
Mailing Address - Fax:253-596-3301
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:TSC-UC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:206-596-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11014598207Q00000X
WAMD60279939207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine