Individual
MRS. MARTHA JEAN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
188 COUNTY ROAD 343, TAYLOR, MS 38673-4541
(662) 236-4543
Mailing address
188 COUNTY ROAD 343, TAYLOR, MS 38673-4541
(662) 236-4543
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
164W00000X
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00770204
—
MS
Enumeration date
01/15/2007
Last updated
07/09/2007
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