Provider Demographics
NPI:1780809996
Name:SHAW, RONNIE MYRNA (PMH-CNS, BC)
Entity type:Individual
Prefix:MRS
First Name:RONNIE
Middle Name:MYRNA
Last Name:SHAW
Suffix:
Gender:F
Credentials:PMH-CNS, BC
Other - Prefix:MRS
Other - First Name:RONNIE
Other - Middle Name:MYRNA
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMH-CNS, BC
Mailing Address - Street 1:101 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-5612
Mailing Address - Country:US
Mailing Address - Phone:303-691-2727
Mailing Address - Fax:
Practice Address - Street 1:101 ALBION ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-5612
Practice Address - Country:US
Practice Address - Phone:303-691-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN52115364S00000X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist