Provider Demographics
NPI:1093030967
Name:SHAW, EVA JANE (CPNP)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:JANE
Last Name:SHAW
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15477 VENTURA BLVD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3006
Mailing Address - Country:US
Mailing Address - Phone:818-907-0322
Mailing Address - Fax:818-907-0360
Practice Address - Street 1:6618 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4617
Practice Address - Country:US
Practice Address - Phone:818-908-9962
Practice Address - Fax:818-908-9914
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311173363LP0200X
CANP 8710363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics