Provider Demographics
NPI:1407515398
Name:SHAW, KATHLEEN P
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:P
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15665 W CIMARRON RD
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NE
Mailing Address - Zip Code:68973-1814
Mailing Address - Country:US
Mailing Address - Phone:402-469-5021
Mailing Address - Fax:
Practice Address - Street 1:15665 W CIMARRON RD
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NE
Practice Address - Zip Code:68973-1814
Practice Address - Country:US
Practice Address - Phone:402-469-5021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No372500000XNursing Service Related ProvidersChore Provider
No172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant