Provider Demographics
NPI:1598985756
Name:SHAW, KATHERINE DALE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:DALE
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:411 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:EARLYSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22936
Mailing Address - Country:US
Mailing Address - Phone:434-960-1553
Mailing Address - Fax:434-982-4058
Practice Address - Street 1:1215 LEIGH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-2488
Practice Address - Fax:434-982-4058
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2010-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024164222363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care