Provider Demographics
NPI:1295332310
Name:SHAW, NADINE PATIENCE
Entity type:Individual
Prefix:MISS
First Name:NADINE
Middle Name:PATIENCE
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 1:3565 CRANSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6339
Mailing Address - Country:US
Mailing Address - Phone:719-306-9512
Mailing Address - Fax:
Practice Address - Street 1:3565 CRANSWOOD WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6339
Practice Address - Country:US
Practice Address - Phone:719-306-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home