Provider Demographics
NPI:1326290628
Name:BILLAU, SHANNON MARIE (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:BILLAU
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE @4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:SUITE #160
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-671-4402
Practice Address - Fax:360-671-9463
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2021-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60237212207Q00000X
MI5101017650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0283411OtherLABOR AND INDUSTIRES
WAG8904665Medicare PIN