Provider Demographics
NPI:1760023469
Name:WHAM, DASHIEL (NP)
Entity type:Individual
Prefix:
First Name:DASHIEL
Middle Name:
Last Name:WHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 S HENRY RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-6006
Mailing Address - Country:US
Mailing Address - Phone:206-557-8403
Mailing Address - Fax:
Practice Address - Street 1:1421 N MEADOWWOOD LN STE 30
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5037
Practice Address - Country:US
Practice Address - Phone:509-990-9470
Practice Address - Fax:509-255-7790
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID56675363LF0000X
NDR44211363LF0000X
WAAP61028233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily