Individual
MS. NANCY JAN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14406 NE 20TH AVE, VANCOUVER, WA 98686-1448
(360) 571-3139
Mailing address
2707 FALK RD, VANCOUVER, WA 98661-5601
(360) 695-3665
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
D160046146
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D1 60046146
DEPARTMENT OF HEALTH
WA
Enumeration date
10/31/2012
Last updated
10/31/2012
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