Provider Demographics
NPI:1912547613
Name:VAN DINGENEN, SHAWN M
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:VAN DINGENEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 E COLUMBIA AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-2342
Mailing Address - Country:US
Mailing Address - Phone:509-862-9563
Mailing Address - Fax:
Practice Address - Street 1:3209 S DEARBORN LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1535
Practice Address - Country:US
Practice Address - Phone:509-862-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty