Individual
VIRGINIA SHAW
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2520 5TH ST N, COLUMBUS, MS 39705-2008
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 75473, BALTIMORE, MD 21275-5473
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R653063
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123160
—
MS
Enumeration date
06/09/2006
Last updated
07/08/2007
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