Provider Demographics
NPI:1639730013
Name:SHAW, ANGELA M (NP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 E STATE ROAD 246
Mailing Address - Street 2:
Mailing Address - City:LEWIS
Mailing Address - State:IN
Mailing Address - Zip Code:47858-9744
Mailing Address - Country:US
Mailing Address - Phone:812-240-5546
Mailing Address - Fax:
Practice Address - Street 1:4757 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4559
Practice Address - Country:US
Practice Address - Phone:812-234-2289
Practice Address - Fax:812-232-4234
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009500A363L00000X
INF02190171363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner