Individual
LAUREN NICOLE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 676-4600
(812) 676-4501
Mailing address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28236095A
IN
363LF0000X
Family Nurse Practitioner
71014076A
IN
363LP2300X
Primary Care Nurse Practitioner
Primary
71014076A
IN
Other
Enumeration date
06/22/2023
Last updated
08/24/2023
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