Provider Demographics
NPI:1740312057
Name:EAGLE, SHANNON (LMP, RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:EAGLE
Suffix:
Gender:F
Credentials:LMP, RN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MOJICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:700 LILLY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5115
Mailing Address - Country:US
Mailing Address - Phone:360-923-7000
Mailing Address - Fax:
Practice Address - Street 1:700 LILLY RD NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5115
Practice Address - Country:US
Practice Address - Phone:360-923-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60170208163WC1500X
WAMA00022115225700000X
WAAP60652210363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner