# SHANNON URSULA WATERMAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1649279860
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | 025209MD00041909 | WA | — |
| 208D00000X | General Practice Physician | MD00041919 | WA | Yes |

## Other

- **Enumeration date:** 07/19/2005
- **Last updated:** 08/05/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 41383885 | — | NM |
| 05 | — | 8505422 | — | WA |
| 01 | — | P00707652 | MEDICARE RAILROAD | — |