Provider Demographics
NPI:1518557347
Name:RADOLL, SHANNON MARIE (CD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:RADOLL
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15633 9TH AVE SW # A
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2105
Mailing Address - Country:US
Mailing Address - Phone:206-473-7503
Mailing Address - Fax:206-913-2268
Practice Address - Street 1:15633 9TH AVE SW # A
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2105
Practice Address - Country:US
Practice Address - Phone:206-473-7503
Practice Address - Fax:206-913-2268
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula