Provider Demographics
NPI:1215362231
Name:SHAW, ETHELYN JANE (EMT)
Entity type:Individual
Prefix:
First Name:ETHELYN
Middle Name:JANE
Last Name:SHAW
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EMT
Mailing Address - Street 1:1623 HOSPITAL LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:OWYHEE
Mailing Address - State:NV
Mailing Address - Zip Code:89832
Mailing Address - Country:US
Mailing Address - Phone:775-757-2415
Mailing Address - Fax:
Practice Address - Street 1:1623 HOSPITAL LOOP ROAD
Practice Address - Street 2:
Practice Address - City:OWYHEE
Practice Address - State:NV
Practice Address - Zip Code:89832
Practice Address - Country:US
Practice Address - Phone:775-757-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10695146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate