Individual
JERRELL WAYNE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3500 INTERSTATE 30 STE B240, MESQUITE, TX 75150-2685
(972) 681-7246
(972) 681-8946
Mailing address
3500 INTERSTATE 30, MESQUITE, TX 75150-2651
(972) 681-7246
(972) 681-8946
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
578398
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00413W
—
TX
Enumeration date
07/27/2007
Last updated
12/18/2007
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