Provider Demographics
NPI:1679272074
Name:TSO, SHAWN MICHELE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHAWN
Middle Name:MICHELE
Last Name:TSO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SHAWN
Other - Middle Name:MICHELE
Other - Last Name:KATSIKAPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-4250
Mailing Address - Country:US
Mailing Address - Phone:360-827-0264
Mailing Address - Fax:
Practice Address - Street 1:727 N TOWER AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4754
Practice Address - Country:US
Practice Address - Phone:360-827-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00174090163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)