Provider Demographics
NPI:1346974649
Name:SHAW, JAIME DEANA (MSN FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:DEANA
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 JACKS WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7217
Mailing Address - Country:US
Mailing Address - Phone:814-312-4256
Mailing Address - Fax:
Practice Address - Street 1:417 SABBATH REST RD STE 3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-7567
Practice Address - Country:US
Practice Address - Phone:814-940-8195
Practice Address - Fax:814-940-8816
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily