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Individual
LAURA J. SHADE
Active
Individual
LAURA J. SHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
28193093
IN
363LN0000X
Neonatal Nurse Practitioner
Primary
71004167
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201005360
—
IN
Enumeration date
11/04/2010
Last updated
09/16/2024
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