Provider Demographics
NPI:1598495111
Name:BOUFFARD, SHAWNA K (RN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:K
Last Name:BOUFFARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19828 88TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-2122
Mailing Address - Country:US
Mailing Address - Phone:425-246-9443
Mailing Address - Fax:
Practice Address - Street 1:19828 88TH AVE NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-2122
Practice Address - Country:US
Practice Address - Phone:425-246-9443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60337665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse