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Individual
SHANNON URSULA WATERMAN
Active
Individual
SHANNON URSULA WATERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
025209MD00041909
WA
208D00000X
General Practice Physician
Primary
MD00041919
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41383885
—
NM
05
—
8505422
—
WA
01
—
P00707652
MEDICARE RAILROAD
—
Enumeration date
07/19/2005
Last updated
08/05/2009
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