Provider Demographics
NPI:1588874523
Name:FITZGERALD, SHAWNA MARIE (LMP)
Entity type:Individual
Prefix:MISS
First Name:SHAWNA
Middle Name:MARIE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6437 S WARNER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4006
Mailing Address - Country:US
Mailing Address - Phone:253-302-5329
Mailing Address - Fax:253-588-1001
Practice Address - Street 1:9004 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2416
Practice Address - Country:US
Practice Address - Phone:253-588-6343
Practice Address - Fax:253-588-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013373174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA190471OtherLABOR AND INDUSTRIES