Doctor Name: | MRS. SHANNON CHRISTIAN SHAW |
NPI Number: | 1053797936 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 2134165 |
Business Practice Address: | 13060 Isle Dr Baxter, MN - 564258331 |
Business Phone Number: | 5129818445 |
Business Fax Number: | |
Mailing Address: | 523 N 3rd St, BRAINERD |
State: | MN |
Postal Code: | 564013054 |
Phone Number: | 2188292861 |
Fax Number: | |
NPI Enumeration Date: | 08/03/2015 |
NPI Last Update Date: | 01/15/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2134165 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |