1407166879 NPI number — MRS. KERI ANNE SHAW MSAOM, LAC, LMP

Table of content: MRS. KERI ANNE SHAW MSAOM, LAC, LMP (NPI 1407166879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407166879 NPI number — MRS. KERI ANNE SHAW MSAOM, LAC, LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
KERI
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSAOM, LAC, LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407166879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4915 48TH AVE. S.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-399-7638
Provider Business Mailing Address Fax Number:
206-725-4543

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1818 WESTLAKE AVE N
Provider Second Line Business Practice Location Address:
STE 126
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-2777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-217-8888
Provider Business Practice Location Address Fax Number:
206-217-8881
Provider Enumeration Date:
10/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC60182089 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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