Provider Demographics
NPI:1336627652
Name:SHAW, CONNIE L (RN BSN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:SHAW
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 FOOT OF TEN RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-5504
Mailing Address - Country:US
Mailing Address - Phone:814-201-0030
Mailing Address - Fax:
Practice Address - Street 1:125 MAPLE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-7920
Practice Address - Country:US
Practice Address - Phone:814-693-2273
Practice Address - Fax:814-693-1191
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN594147163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health