Provider Demographics
NPI:1932332889
Name:SHAW, MARENA LYNNE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARENA
Middle Name:LYNNE
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:703-383-4836
Mailing Address - Fax:
Practice Address - Street 1:8505 ARLINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4630
Practice Address - Country:US
Practice Address - Phone:703-698-8525
Practice Address - Fax:703-698-8527
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily