Basic Information
| Provider Information | |||||||||
| NPI: | 1023598000 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHDO | ||||||||
| FirstName: | JESSICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16510 187TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | WOODINVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980729187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064917171 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13718 100TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980345216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258144888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2018 | ||||||||
| LastUpdateDate: | 08/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP60889442 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.