Provider Demographics
NPI:1376189555
Name:FERNANDEZ, SHANEEN S (DNP, CNM, ARNP)
Entity Type:Individual
Prefix:
First Name:SHANEEN
Middle Name:S
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:DNP, CNM, ARNP
Other - Prefix:
Other - First Name:SHANEEN
Other - Middle Name:S
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5196
Mailing Address - Country:US
Mailing Address - Phone:360-923-7000
Mailing Address - Fax:360-923-7089
Practice Address - Street 1:700 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5115
Practice Address - Country:US
Practice Address - Phone:360-923-7000
Practice Address - Fax:360-923-7089
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61010393367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife