Provider Demographics
NPI:1750048732
Name:SHAW, CRAIG
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15665 W CIMARRON RD
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NE
Mailing Address - Zip Code:68973-1814
Mailing Address - Country:US
Mailing Address - Phone:402-756-5577
Mailing Address - Fax:
Practice Address - Street 1:706 N BARNES AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4219
Practice Address - Country:US
Practice Address - Phone:402-469-4536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver