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Individual
STACIE R SHAW
Active
Individual
STACIE R SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1117
WI
363A00000X
Physician Assistant
Primary
5601005068
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0N41200012
MICHIGAN MEDICARE
MI
01
—
1031550
NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS
—
05
—
42982000
—
WI
Enumeration date
08/30/2006
Last updated
01/05/2026
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