Provider Demographics
NPI:1063434009
Name:GEIGER, SHANNA R (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:R
Last Name:GEIGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12039 NE 128TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3029
Mailing Address - Country:US
Mailing Address - Phone:425-899-1220
Mailing Address - Fax:425-899-1221
Practice Address - Street 1:12039 NE 128TH ST STE 500
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3029
Practice Address - Country:US
Practice Address - Phone:425-899-1230
Practice Address - Fax:425-899-1221
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3197363A00000X
FLPA9110554363A00000X
WA61138370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ952300Medicaid
AZZ173505Medicare PIN