Provider Demographics
NPI:1205335809
Name:STROUTH-SHAW, SHAWNA (NP)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:STROUTH-SHAW
Suffix:
Gender:F
Credentials:NP
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 1512
Mailing Address - Street 2:
Mailing Address - City:WARD COVE
Mailing Address - State:AK
Mailing Address - Zip Code:99928-1512
Mailing Address - Country:US
Mailing Address - Phone:907-821-8073
Mailing Address - Fax:
Practice Address - Street 1:320 BAWDEN ST APT 313
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6544
Practice Address - Country:US
Practice Address - Phone:907-220-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK129177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily