Provider Demographics
NPI:1356506885
Name:SHAW, JACQUELINE LOIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LOIS
Last Name:SHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:LOIS
Other - Last Name:CALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:661 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141
Mailing Address - Country:US
Mailing Address - Phone:716-592-4807
Mailing Address - Fax:
Practice Address - Street 1:661 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141
Practice Address - Country:US
Practice Address - Phone:716-592-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4092241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse