Provider Demographics
NPI:1215747035
Name:NEWKIRK, SHANELL (NAR, HCA, MA)
Entity type:Individual
Prefix:
First Name:SHANELL
Middle Name:
Last Name:NEWKIRK
Suffix:
Gender:F
Credentials:NAR, HCA, MA
Other - Prefix:
Other - First Name:SHANELL
Other - Middle Name:
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17314 10TH AVE S UNIT A1
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:721 FAWCETT AVE STE 100
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5502
Practice Address - Country:US
Practice Address - Phone:253-302-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide