Provider Demographics
NPI:1134120181
Name:SHAW, LAURA DE MAURIAC (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DE MAURIAC
Last Name:SHAW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9212 BURR OAK ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-8346
Mailing Address - Country:US
Mailing Address - Phone:405-377-0418
Mailing Address - Fax:
Practice Address - Street 1:1411 W 7TH ST
Practice Address - Street 2:STE 102
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4300
Practice Address - Country:US
Practice Address - Phone:405-624-8222
Practice Address - Fax:405-372-3769
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0027775363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1727775Medicaid