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Individual

NATHAN LEVI SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PMHNP

Contact information

Practice address
2500 E SHOW LOW LAKE RD, SHOW LOW, AZ 85901-7994
(928) 537-2951
Mailing address
180 E 1ST ST S, SNOWFLAKE, AZ 85937-5311
(480) 993-4674

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
AP10203
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP10203
AZ

Other

Enumeration date
06/08/2017
Last updated
05/07/2020
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