Provider Demographics
NPI:1659098630
Name:SHAW, JOSEPHINE (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:KILTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-2216
Mailing Address - Country:US
Mailing Address - Phone:508-367-4359
Mailing Address - Fax:
Practice Address - Street 1:78 HIGH ST
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2216
Practice Address - Country:US
Practice Address - Phone:508-367-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH083418-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily