Provider Demographics
NPI:1073698114
Name:SHAWL, CYNTHIA B (CNM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:SHAWL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-6012
Mailing Address - Country:US
Mailing Address - Phone:301-524-9515
Mailing Address - Fax:
Practice Address - Street 1:557 HOLDEN RD
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-6012
Practice Address - Country:US
Practice Address - Phone:301-524-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160990367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife