Provider Demographics
NPI:1831641570
Name:UNDERWOOD, SHIRLA (RVT/RDCS)
Entity Type:Individual
Prefix:
First Name:SHIRLA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:RVT/RDCS
Other - Prefix:
Other - First Name:SHIRLA
Other - Middle Name:
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RVT/RDCS
Mailing Address - Street 1:P.O. BOX 385
Mailing Address - Street 2:3705 S MOLTER RD
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019
Mailing Address - Country:US
Mailing Address - Phone:509-435-6363
Mailing Address - Fax:
Practice Address - Street 1:3705 S MOLTER RD
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019
Practice Address - Country:US
Practice Address - Phone:509-435-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA54153246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography