Individual
BRENDA J SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1660 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4360
(208) 523-8844
(208) 529-8684
Mailing address
1660 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4360
(208) 523-8844
(208) 529-8684
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA587
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807324700
—
ID
Enumeration date
11/07/2006
Last updated
12/15/2009
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