Provider Demographics
NPI:1467675843
Name:SHAW, COLEEN K (RN, NP)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:K
Last Name:SHAW
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:JOBST TOWER #640
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-291-8892
Mailing Address - Fax:419-291-6436
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:JOBST TOWER #640
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-291-8892
Practice Address - Fax:419-291-6436
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.128821-COA1163W00000X
OHCOA.01644-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics