Individual
SHANNON SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 LAKERIDGE DR SW, OLYMPIA, WA 98502-6001
(360) 754-2941
Mailing address
9039 SILVERSPOT DR SE, TUMWATER, WA 98501-5575
(360) 791-7133
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP60571003
WA
Other
Enumeration date
08/06/2015
Last updated
04/19/2017
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