Individual
KATHLEEN P SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15665 W CIMARRON RD, ROSELAND, NE 68973-1814
(402) 469-5021
Mailing address
15665 W CIMARRON RD, ROSELAND, NE 68973-1814
(402) 469-5021
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
372500000X
Chore Provider
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Enumeration date
12/08/2021
Last updated
02/03/2025
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