Provider Demographics
NPI:1316126667
Name:HIRST, SHANNON KATHLEEN (ND)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:HIRST
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 140TH AVE NE UNIT E102
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6929
Mailing Address - Country:US
Mailing Address - Phone:206-618-6549
Mailing Address - Fax:855-810-3192
Practice Address - Street 1:17000 140TH AVE NE UNIT E102
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6929
Practice Address - Country:US
Practice Address - Phone:206-618-6549
Practice Address - Fax:855-810-3192
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001593175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath