Provider Demographics
NPI:1225624273
Name:SHAW, RHIANNA SUE (APRN-FNPC)
Entity Type:Individual
Prefix:
First Name:RHIANNA
Middle Name:SUE
Last Name:SHAW
Suffix:
Gender:F
Credentials:APRN-FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 THUNDERBIRD LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-9386
Mailing Address - Country:US
Mailing Address - Phone:620-360-1213
Mailing Address - Fax:
Practice Address - Street 1:109 W BLAND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-5708
Practice Address - Country:US
Practice Address - Phone:575-622-7337
Practice Address - Fax:575-623-3498
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM62110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily