Provider Demographics
NPI:1326625054
Name:SHAW, LINDSEY (APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BLOOMFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43103-1029
Mailing Address - Country:US
Mailing Address - Phone:740-983-0015
Mailing Address - Fax:
Practice Address - Street 1:5030 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SOUTH BLOOMFIELD
Practice Address - State:OH
Practice Address - Zip Code:43103-1018
Practice Address - Country:US
Practice Address - Phone:740-983-0015
Practice Address - Fax:740-983-4763
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029608363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0467322Medicaid