Provider Demographics
NPI:1083457204
Name:SHEARD, PATRICK
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SHEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23708 65TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-7420
Mailing Address - Country:US
Mailing Address - Phone:801-349-8621
Mailing Address - Fax:
Practice Address - Street 1:23708 65TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-7420
Practice Address - Country:US
Practice Address - Phone:801-349-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAL661441673164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse