Provider Demographics
NPI:1386155232
Name:SHAW, WILMA X (NTP)
Entity type:Individual
Prefix:MS
First Name:WILMA
Middle Name:
Last Name:SHAW
Suffix:X
Gender:F
Credentials:NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 NW 73RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-6268
Mailing Address - Country:US
Mailing Address - Phone:206-898-7299
Mailing Address - Fax:206-898-7299
Practice Address - Street 1:6300 9TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8516
Practice Address - Country:US
Practice Address - Phone:206-898-7299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2344133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education