Provider Demographics
NPI:1790785764
Name:WEATHERBY, SHAUNA R (ARNP)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:R
Last Name:WEATHERBY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:STE 104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4250
Mailing Address - Country:US
Mailing Address - Phone:253-272-5572
Mailing Address - Fax:253-272-5699
Practice Address - Street 1:314 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:STE 104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4250
Practice Address - Country:US
Practice Address - Phone:253-272-5572
Practice Address - Fax:253-272-5699
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP0001461363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB32471Medicare ID - Type Unspecified
WAP65090Medicare UPIN