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Individual
NICOLE B SHAW
Active
Individual
NICOLE B SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005611A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28202395A
REGISTERED NURSE LICENSE
IN
01
—
F0714303
FAMILY NURSE PRACTITIONER LICENSE
IN
Enumeration date
11/17/2015
Last updated
10/07/2022
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