Provider Demographics
NPI:1881603496
Name:TONNES, SHAVONNE C (PAC)
Entity type:Individual
Prefix:MRS
First Name:SHAVONNE
Middle Name:C
Last Name:TONNES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:SHAVONNE
Other - Middle Name:L
Other - Last Name:COLEBROOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6307 147TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-3649
Mailing Address - Country:US
Mailing Address - Phone:425-742-7953
Mailing Address - Fax:425-742-3683
Practice Address - Street 1:707 228TH ST SW
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-9799
Practice Address - Country:US
Practice Address - Phone:425-742-7953
Practice Address - Fax:425-742-3683
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
7340T0OtherROGENCE BLUE SHIELD
WA0195262OtherDEPT OF LABOR INDUSTRY
P00206112OtherRAIL ROAD MEDICARE
WA8422560Medicaid
WA0195262OtherDEPT OF LABOR INDUSTRY
7340T0OtherROGENCE BLUE SHIELD