Provider Demographics
NPI:1629690714
Name:SHOVLAIN, SANDRA RUTH (RN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:RUTH
Last Name:SHOVLAIN
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:P.O. BOX 88638
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388
Mailing Address - Country:US
Mailing Address - Phone:253-507-4367
Mailing Address - Fax:253-507-8330
Practice Address - Street 1:909 5TH ST
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-1807
Practice Address - Country:US
Practice Address - Phone:253-507-4367
Practice Address - Fax:253-507-8330
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00071615163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management