Provider Demographics
NPI:1962908996
Name:SHAE, CARRIANN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIANN
Middle Name:MARIE
Last Name:SHAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W 8TH AVE STE 6020
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2328
Mailing Address - Country:US
Mailing Address - Phone:509-455-5050
Mailing Address - Fax:509-624-5034
Practice Address - Street 1:105 W 8TH AVE STE 6020
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2328
Practice Address - Country:US
Practice Address - Phone:509-455-5050
Practice Address - Fax:509-624-5034
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61309804207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program