Basic Information
Provider Information
NPI: 1003002379
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHRESTHA
FirstName: SALONA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5410 MARYLAND WAY
Address2: SUITE 300
City: BRENTWOOD
State: TN
PostalCode: 370275064
CountryCode: US
TelephoneNumber: 6153775600
FaxNumber:  
Practice Location
Address1: 400 NE MOTHER JOSEPH PL
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986643200
CountryCode: US
TelephoneNumber: 3605143727
FaxNumber: 3605143711
Other Information
ProviderEnumerationDate: 09/20/2007
LastUpdateDate: 02/02/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD00048484WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
P0046866201WARR MEDICAREOTHER
838968605WA MEDICAID
P004866201WARR MEDICAREOTHER
849723205WA MEDICAID


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