Provider Demographics
NPI:1376294652
Name:VAN CAPELLE, SHANE J (CG)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:J
Last Name:VAN CAPELLE
Suffix:
Gender:M
Credentials:CG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 PORTAL WAY
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8316
Mailing Address - Country:US
Mailing Address - Phone:832-715-6067
Mailing Address - Fax:
Practice Address - Street 1:4120 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6471
Practice Address - Country:US
Practice Address - Phone:360-922-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist