Provider Demographics
NPI:1396908414
Name:SHAW, MARLENE ANNE (FNP)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:ANNE
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP
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 6
Mailing Address - Street 2:
Mailing Address - City:MINT SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24463-0006
Mailing Address - Country:US
Mailing Address - Phone:540-337-2930
Mailing Address - Fax:
Practice Address - Street 1:55 MINT SPRING CIRCLE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-337-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily