Basic Information
| Provider Information | |||||||||
| NPI: | 1740482579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHELTON FAMILY MEDICINE P.L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 939 MOUNTAIN VIEW DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SHELTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985844410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604262653 | ||||||||
| FaxNumber: | 3604277086 | ||||||||
| Practice Location | |||||||||
| Address1: | 939 MOUNTAIN VIEW DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SHELTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985844410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604262653 | ||||||||
| FaxNumber: | 3604277086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 10/16/2014 | ||||||||
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| AuthorizedOfficialLastName: | LANMAN | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSISTANT OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3604262653 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.