Provider Demographics
NPI:1538179460
Name:BRENDA SHANLEY ARNP, INC.
Entity type:Organization
Organization Name:BRENDA SHANLEY ARNP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-928-5911
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-0008
Mailing Address - Country:US
Mailing Address - Phone:509-928-5911
Mailing Address - Fax:509-928-3911
Practice Address - Street 1:408 N MULLAN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-3863
Practice Address - Country:US
Practice Address - Phone:509-928-5911
Practice Address - Fax:509-928-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007025363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9648742Medicaid
WAG8860785Medicare PIN