Provider Demographics
NPI:1437179546
Name:CHARLES, SHANA (ARNP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3624 ENSIGN RD NE STE F
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5114
Mailing Address - Country:US
Mailing Address - Phone:360-226-8153
Mailing Address - Fax:
Practice Address - Street 1:3624 ENSIGN RD NE STE F
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5114
Practice Address - Country:US
Practice Address - Phone:360-226-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006938363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9645052Medicaid
WA9645052Medicaid