Shannon Kelly Rastetter, RN

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

RN60179026 Issued in WA

Practice address

160 NW Gilman Blvd Ste 406
Issaquah, WA 98027-2549

Phone

(206) 523-1212

NPI assigned

Oct 18, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1235892167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13606 231ST PL SE",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278455",
            "telephone_number": "206-660-5602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 NW GILMAN BLVD STE 406",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272549",
            "telephone_number": "206-523-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RASTETTER",
        "first_name": "SHANNON",
        "middle_name": "KELLY",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-18",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "WA",
            "license": "RN60179026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "OTHER",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lactation Consultant (Registered Nurse) in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Lactation Consultant (Registered Nurse) in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.