Individual
ANNETTA M SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,BSN,CRNFA
Contact information
Practice address
3807 GREENLEAF AVE NW, BEMIDJI, MN 56601-5817
(218) 751-9746
(218) 759-0620
Mailing address
3807 GREENLEAF AVE NW, BEMIDJI, MN 56601-5817
(218) 751-9746
(218) 759-0620
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
855911029535
PREFFEREDONE
MN
01
—
85G67SH
BLUE CROSS BLUE SHIELD
MN
Enumeration date
01/25/2007
Last updated
07/08/2007
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