Provider Demographics
NPI:1467122762
Name:FOE, SHAWN KATRINA (BCHN)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:KATRINA
Last Name:FOE
Suffix:
Gender:F
Credentials:BCHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WALL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:ID
Mailing Address - Zip Code:83552-5052
Mailing Address - Country:US
Mailing Address - Phone:602-750-5799
Mailing Address - Fax:
Practice Address - Street 1:550 WALL CREEK RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:ID
Practice Address - Zip Code:83552-5052
Practice Address - Country:US
Practice Address - Phone:602-750-5799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174H00000XOther Service ProvidersHealth Educator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner