Provider Demographics
NPI:1912561903
Name:SHAW, JERRI LYNN
Entity Type:Individual
Prefix:MS
First Name:JERRI
Middle Name:LYNN
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:PAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74058-2036
Mailing Address - Country:US
Mailing Address - Phone:918-762-1045
Mailing Address - Fax:
Practice Address - Street 1:540 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2036
Practice Address - Country:US
Practice Address - Phone:918-762-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist