Provider Demographics
NPI:1104581636
Name:SHEA, KATHERINE (LAC, MACOM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 NW 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2846
Mailing Address - Country:US
Mailing Address - Phone:860-967-9375
Mailing Address - Fax:
Practice Address - Street 1:3401 EVANSTON AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8677
Practice Address - Country:US
Practice Address - Phone:860-967-9375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist