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Individual

CHARLOTTE B SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
510 S WASHINGTON ST, BASTROP, LA 71220-5033
(318) 281-8110
(318) 281-8099
Mailing address
510 S WASHINGTON ST, BASTROP, LA 71220-5033
(318) 281-8110
(318) 281-8099

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA200515
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2316729
LA
01
PA200515
PA-C
LA
Enumeration date
02/01/2012
Last updated
07/01/2014
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