Individual
ALICE CATHERINE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4440 N PORTAGE AVE, SOUTH BEND, IN 46628-9570
(574) 204-6200
Mailing address
4440 N PORTAGE AVE, SOUTH BEND, IN 46628
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
58326
WY
363LF0000X
Family Nurse Practitioner
Primary
71010179A
IN
Other
Enumeration date
07/14/2020
Last updated
02/26/2026
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