Provider Demographics
NPI:1982191052
Name:BRENCICK HIGMAN, SHELLEY RENE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:RENE
Last Name:BRENCICK HIGMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:RENE
Other - Last Name:HIGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 E KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 E KINCAID ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-2501
Practice Address - Fax:360-428-2596
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61177642207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program