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Individual
SUSAN M SHAW
Active
Individual
SUSAN M SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000556A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000543000
ANTHEM PIN
IN
05
—
200406290
—
IN
01
—
200859330E
MEDICAID GROUP
IN
01
—
250470
MEDICARE GROUP
IN
Enumeration date
04/19/2007
Last updated
11/06/2017
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