Provider Demographics
NPI:1861683799
Name:PURCELL, SHAWNA E
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:E
Last Name:PURCELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:E
Other - Last Name:ADOLPHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 YAUGER WAY SW STE 100
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8152
Mailing Address - Country:US
Mailing Address - Phone:360-596-4614
Mailing Address - Fax:360-596-4889
Practice Address - Street 1:404 YAUGER WAY SW STE 100
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8152
Practice Address - Country:US
Practice Address - Phone:360-596-4614
Practice Address - Fax:360-596-4889
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60101885207R00000X
ORLL17327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine