Individual provider Active NPI

Shawn Marie Madziwa, ARNP, FNP-C, RN

  • Family Nurse Practitioner
  • Lynnwood, WA
National Provider Identifier
1154737534
Registry record updated May 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP60488948 Issued in WA
Practice address
4111 194TH St SW
Lynnwood, WA 98036-4604
Phone
(425) 835-5200
NPI assigned
Jul 7, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN60486451 WA
Registered Nurse 163W00000X 201808802RN OR
General Practice Registered Nurse 163WG0000X RN226145 GA
Nurse Practitioner 363L00000X AP60488948 WA
Family Nurse Practitioner 363LF0000X 201809996NP-PP OR
Advanced Practice Midwife 367A00000X AP60569998 WA
Family Nurse Practitioner 363LF0000X AP60488948 WA Primary

Addresses

Primary practice location

4111 194TH St SW
Lynnwood, WA 98036-4604

Mailing address

4111 194TH St SW
Lynnwood, WA 98036-4604
Phone (425) 835-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140902000871 WA Practitioner - Nurse Practitioner 7416175534 Reassigns benefits to 1 organization
I20190221001884 OR Practitioner - Nurse Practitioner 7416175534 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
201808802RNORMDRegistered Nurse
RN60486451WAMDRegistered Nurse
RN226145GAMDGeneral Practice Registered Nurse
AP60569998WAMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center of Snohomish County CurrentSince May 9, 2022 Accepting new patients
Community Health Center of Snohomish County CurrentSince May 9, 2022 Accepting new patients
Samaritan Pacific Health Services, Inc Current Accepting new patients
Neighborcare Health Past Accepting new patients

Locations

777 NW 9th St
Ste 102
Corvallis, OR 97330
Phone (541) 768-6769

930 SW Abbey St
Newport, OR 97365
Phone (541) 265-2244

1010 SW Coast Hwy
Ste 201
Newport, OR 97365
Phone (541) 257-6393

326 S Stillaguamish Ave
Arlington, WA 98223
Phone (360) 435-2144

23320 Highway 99
Edmonds, WA 98026
Phone (425) 640-5500

1019 112th St SW
Everett, WA 98204
Phone (425) 551-6001

8609 Evergreen Way
Everett, WA 98208
Phone (425) 551-6200

930 N Broadway
Everett, WA 98201
Phone (425) 317-0300

1424 Broadway
Everett, WA 98201
Phone (425) 551-1000

4201 Rucker Ave
Everett, WA 98203
Phone (425) 382-4000

6002 168th St SW
Bldg B
Lynnwood, WA 98037

4111 194th St SW
Lynnwood, WA 98036
Phone (425) 835-5200

21801 44th Ave W
Mountlake Terrace, WA 98043
Phone (425) 431-1080

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651622400000",
    "number": "1154737534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 194TH ST SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364604",
            "telephone_number": "425-835-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 194TH ST SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980364604",
            "telephone_number": "425-835-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADZIWA",
        "first_name": "SHAWN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "ARNP, FNP-C, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN60486451",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201808802RN",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "GA",
            "license": "RN226145",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60488948",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201809996NP-PP",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WA",
            "license": "AP60569998",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60488948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

Verify at the official NPI Registry.