Provider Demographics
NPI:1710177340
Name:SHAW, LAURA M (DNP)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:309 FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53952-9309
Mailing Address - Country:US
Mailing Address - Phone:608-432-4978
Mailing Address - Fax:
Practice Address - Street 1:309 FREEDOM RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:WI
Practice Address - Zip Code:53952-9309
Practice Address - Country:US
Practice Address - Phone:608-432-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI89-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner