Waterman, Shannon Ursula
Waterman, Shannon Ursula is an individual health care provider with primary practice located at 11225 Pacific Avenue Parkland Clinic Community Healthcare, Tacoma WA 98444. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / General Practice is her primary health care specialty. Waterman, Shannon Ursula can be contacted via phone (253) 536-2020.Contact Information
Primary practice address
11225 Pacific Avenue Parkland Clinic Community Healthcare
Tacoma WA 98444
Phone: (253) 536-2020
Fax: (253) 536-5327
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 025209MD00041909 | Washington |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | MD00041919 | Washington |
Profile Details
| NPI number | 1649279860 |
|---|---|
| LBN Legal business name | Waterman, Shannon Ursula |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2005 |
| Last updated | Aug 5th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649279860 | NPPES |
| Washington | MEDICAID | 8505422 | |
| Washington | MEDICAID | 41383885 | |
| Washington | Other | P00707652 |
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