Provider Demographics
NPI:1982798419
Name:SHAW, ROSEMARIE ANTON (CRNP)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:ANTON
Last Name:SHAW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 MALCOLM DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-848-0364
Mailing Address - Fax:410-848-4037
Practice Address - Street 1:412 MALCOLM DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-848-0364
Practice Address - Fax:410-848-4037
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR107669363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD461810600Medicaid
MD461810600Medicaid
MD882L 257EMedicare ID - Type Unspecified