Provider Demographics
NPI:1306238654
Name:SHUE, PATRICIA LEA (PNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEA
Last Name:SHUE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W SPRUCE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5371
Mailing Address - Country:US
Mailing Address - Phone:307-324-8717
Mailing Address - Fax:307-327-8496
Practice Address - Street 1:1016 W SPRUCE ST UNIT A
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5371
Practice Address - Country:US
Practice Address - Phone:307-324-8717
Practice Address - Fax:307-327-8496
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY31544.1227363LP0200X
IN28154600A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics