Individual
MR. SHANE A. WALTER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
BHC BANGOR, 2050 BARB ST, SUITE A, NAVAL SUBMARINE BASE BANGOR, SILVERDALE, WA 98315-2099
(360) 315-4356
(360) 396-4247
Mailing address
790 NE SHOREWOOD CT, POULSBO, WA 98370-8436
(360) 598-5312
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
0I1002X171
WA
Other
Enumeration date
03/08/2006
Last updated
07/08/2007
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