Provider Demographics
NPI:1124250030
Name:NORTON, SHAYNE PATRICK (SPN)
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:PATRICK
Last Name:NORTON
Suffix:
Gender:M
Credentials:SPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 S 317TH ST APT 305
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5028
Mailing Address - Country:US
Mailing Address - Phone:206-766-0806
Mailing Address - Fax:
Practice Address - Street 1:1201 3RD AVE STE 450
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3000
Practice Address - Country:US
Practice Address - Phone:206-766-0806
Practice Address - Fax:206-447-2228
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA214782133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist