Individual
ANDREA LYN SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
900 W RACE ST, RIDGWAY, IL 62979-1150
(618) 272-8831
(618) 272-7118
Mailing address
900 W RACE ST, RIDGWAY, IL 62979-1150
(618) 272-8831
(618) 272-7118
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043119608
IL
Other
Enumeration date
10/20/2021
Last updated
10/20/2021
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