Provider Demographics
NPI:1770503666
Name:SHAW-BATTISTA, JENNIFER C (PHD, RN, NP, CNM,)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:C
Last Name:SHAW-BATTISTA
Suffix:
Gender:F
Credentials:PHD, RN, NP, CNM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 OESTE DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1850
Mailing Address - Country:US
Mailing Address - Phone:530-220-3107
Mailing Address - Fax:
Practice Address - Street 1:2051 JOHN JONES RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9701
Practice Address - Country:US
Practice Address - Phone:530-758-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN557883163W00000X
CANP12711363LW0102X
CANMF1510367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN557883Medicaid
P41785Medicare UPIN
CAZZZ03485ZMedicare ID - Type Unspecified