Provider Demographics
NPI:1154213999
Name:BETHUNE, SHANNA LYNN (NP)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:LYNN
Last Name:BETHUNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:LYNN
Other - Last Name:PLEMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30809 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4074
Mailing Address - Country:US
Mailing Address - Phone:253-839-2030
Mailing Address - Fax:253-839-1071
Practice Address - Street 1:30809 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4074
Practice Address - Country:US
Practice Address - Phone:253-839-2030
Practice Address - Fax:253-839-1071
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP70015666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily