Individual
MARRISA L SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
884 W PARK AVE, PORT TOWNSEND, WA 98368-2273
(360) 385-0321
Mailing address
PO BOX 565, PORT TOWNSEND, WA 98368-0565
(360) 385-0321
(360) 385-3944
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
CO60925720
WA
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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