Provider Demographics
NPI:1902854045
Name:SHAW, LINDA C (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1780
Mailing Address - Country:US
Mailing Address - Phone:970-300-1845
Mailing Address - Fax:970-300-1846
Practice Address - Street 1:100 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1780
Practice Address - Country:US
Practice Address - Phone:970-300-1845
Practice Address - Fax:970-300-1846
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO4679363LP0808X
CO4678364SP0809X
CO172076163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO28182316Medicaid
COS96043Medicare UPIN
CO802404Medicare PIN