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Individual
JORDAN ANTHONY SHAW
Active
Individual
JORDAN ANTHONY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
14-140762-091
KS
363LA2100X
Acute Care Nurse Practitioner
Primary
53-78418
KS
Other
Enumeration date
09/12/2018
Last updated
02/21/2025
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