Individual
AUDREY JEAN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8354 100TH AVE STE 1, STANWOOD, MI 49346-8345
(231) 972-6000
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009531
MI
Other
Enumeration date
11/13/2018
Last updated
05/13/2022
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