Individual
REVONNA SHANTAY KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2212 S JACKSON ST, SEATTLE, WA 98144-2591
(206) 322-2387
Mailing address
2212 S JACKSON ST, SEATTLE, WA 98144-2591
(206) 322-2387
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00036735
WA
Other
Enumeration date
12/01/2025
Last updated
12/01/2025
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