Provider Demographics
NPI:1891139051
Name:SHAW, JENNIFER K (RD CD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:K
Last Name:SHAW
Suffix:
Gender:F
Credentials:RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N113W16278 SYLVAN CIR UNIT C
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6032
Mailing Address - Country:US
Mailing Address - Phone:414-238-3181
Mailing Address - Fax:
Practice Address - Street 1:W129N7055 NORTHFIELD DR BLDG A
Practice Address - Street 2:ENDOCRINOLOGY CLINIC
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1950-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered