Individual
ALICIA C SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
300 N MORLEY ST STE A-C, MOBERLY, MO 65270-2334
(660) 263-1225
(660) 263-1613
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(660) 263-1225
(660) 263-1613
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2016043696
MO
363LF0000X
Family Nurse Practitioner
A153239
IA
Other
Enumeration date
12/28/2016
Last updated
02/01/2019
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