Individual
SUSAN LEE SHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
390 FOUNDERS WAY, SUITE 1, FORKS, WA 98331-9062
(360) 374-9180
(360) 374-3162
Mailing address
PO BOX 153, 411 CALAWAH, FORKS, WA 98331-0153
(360) 374-9180
(360) 374-3162
Taxonomy
Speciality
Code
Description
License number
State
163WW0101X
Ambulatory Women's Health Care Registered Nurse
RN00050684
WA
364SW0102X
Women's Health Clinical Nurse Specialist
Primary
AP30000331
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9607458
—
WA
Enumeration date
07/28/2006
Last updated
06/29/2011
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