Provider Demographics
NPI:1982968103
Name:SHUMWAY, NORA K (MD)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:K
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:866-630-9882
Mailing Address - Fax:920-682-5810
Practice Address - Street 1:201BJC ST. PETERS DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3385
Practice Address - Country:US
Practice Address - Phone:636-277-0073
Practice Address - Fax:636-277-0074
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2016011558207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125.060868Medicaid