Provider Demographics
NPI:1417519943
Name:SHAW, ELEANOR R (FNP)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:R
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 STATE ROUTE 521
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8754
Mailing Address - Country:US
Mailing Address - Phone:973-598-5150
Mailing Address - Fax:
Practice Address - Street 1:2257 STATE ROUTE 521
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8754
Practice Address - Country:US
Practice Address - Phone:973-598-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-04
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF05190831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily