Individual
DEBRA LYNN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3400 WEST 66TH STREET, SUITE 290, EDINA, MN 55435
(952) 914-1882
(952) 914-1727
Mailing address
10973 233RD AVE NW, ELK RIVER, MN 55330
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R144120-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500004309
MEDICARE
MN
05
—
6409270-00
—
MN
Enumeration date
11/16/2006
Last updated
03/11/2021
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