Individual
NICOLE LYNN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
850 S HEALTH PARKWAY, THREE RIVERS, MI 49093-8358
(269) 279-5240
(269) 273-9060
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704299077
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417627589
—
MI
Enumeration date
09/20/2021
Last updated
11/25/2024
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