Provider Demographics
NPI:1295006187
Name:SPECIALTY WOUND AND FOOT CARE
Entity Type:Organization
Organization Name:SPECIALTY WOUND AND FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:GNP
Authorized Official - Phone:253-536-2504
Mailing Address - Street 1:4901 108TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3724
Mailing Address - Country:US
Mailing Address - Phone:253-584-3577
Mailing Address - Fax:
Practice Address - Street 1:4901 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3724
Practice Address - Country:US
Practice Address - Phone:253-584-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP300003906363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty