Provider Demographics
NPI:1912775529
Name:MARTIN, SHANNON MITCHELL (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MITCHELL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 NW 136TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1686
Mailing Address - Country:US
Mailing Address - Phone:360-921-9421
Mailing Address - Fax:
Practice Address - Street 1:1418 NW 136TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-1686
Practice Address - Country:US
Practice Address - Phone:360-921-9421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00175787163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant