Provider Demographics
NPI:1417766973
Name:SHAW, RICKI MARITA (ACNP)
Entity type:Individual
Prefix:
First Name:RICKI
Middle Name:MARITA
Last Name:SHAW
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FURMAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-4709
Mailing Address - Country:US
Mailing Address - Phone:864-520-3054
Mailing Address - Fax:
Practice Address - Street 1:2 FURMAN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-4709
Practice Address - Country:US
Practice Address - Phone:864-520-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29614363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care