Provider Demographics
NPI:1396821849
Name:SHAW, SONYA (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 YUCCA RD
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2747
Mailing Address - Country:US
Mailing Address - Phone:907-310-1171
Mailing Address - Fax:
Practice Address - Street 1:30 YUCCA RD
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2747
Practice Address - Country:US
Practice Address - Phone:907-310-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997950-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily