Provider Demographics
NPI:1821110248
Name:SHAW, ANN MARIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ANN MARIE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6521 RAVENS CREST DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-2431
Mailing Address - Country:US
Mailing Address - Phone:609-799-8612
Mailing Address - Fax:
Practice Address - Street 1:6521 RAVENS CREST DR
Practice Address - Street 2:
Practice Address - City:PLAINSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08536-2431
Practice Address - Country:US
Practice Address - Phone:609-799-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP02866200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse