Provider Demographics
NPI:1518994615
Name:KIRCHNER, SHANNAN (MD)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 SHERIDAN ST
Mailing Address - Street 2:SUITE B103
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2931
Mailing Address - Country:US
Mailing Address - Phone:360-385-4848
Mailing Address - Fax:360-379-4383
Practice Address - Street 1:915 SHERIDAN ST
Practice Address - Street 2:SUITE B103
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2931
Practice Address - Country:US
Practice Address - Phone:360-385-4848
Practice Address - Fax:360-379-4383
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA183597207Q00000X
WAMD00037547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAL & IOther0208858
WA8861893OtherMEDICARE RHC
WA8807737Medicaid
WA8861893OtherMEDICARE RHC
WAG85317Medicare UPIN