Provider Demographics
NPI:1053110106
Name:SHRESTHA, SHAMBHU (RN, BSN)
Entity type:Individual
Prefix:
First Name:SHAMBHU
Middle Name:
Last Name:SHRESTHA
Suffix:
Gender:
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 HOGAN DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98513-4922
Mailing Address - Country:US
Mailing Address - Phone:443-848-9192
Mailing Address - Fax:
Practice Address - Street 1:6220 HOGAN DR SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-4922
Practice Address - Country:US
Practice Address - Phone:443-848-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60868712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty