Provider Demographics
NPI:1669520706
Name:WARREN, LINDA SHIPLEY (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SHIPLEY
Last Name:WARREN
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 1:1100 OLIVE WAY MSC M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:380 WINSLOW WAY E
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2424
Practice Address - Country:US
Practice Address - Phone:206-842-5631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8154692Medicaid
WA0039577OtherLABOR AND INDUSTRIES #
WAWA6998OtherBLUE SHIELD #
WAUS0900030OtherAETNA SPECIALIST PIN
WA8154692Medicaid
WA0039577OtherLABOR AND INDUSTRIES #