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1790161222
SHANNON SLACK
OLYMPIA, WA
NPI
1790161222
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: WA AP60571003)
Enumeration Date
2015-08-06
Last Update Date
2017-04-19
Business Address
-- SHANNON SLACK
2000 LAKERIDGE DR SW
OLYMPIA, WA 98502-6001
Phone number: 360-754-2941
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Mailing Address
-- SHANNON SLACK
9039 SILVERSPOT DR SE
TUMWATER, WA 98501-5575
Phone number: 360-791-7133
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