Provider Demographics
NPI:1427283811
Name:SHAW, PATRICIA ANN (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:PATRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4351 E LOHMAN AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8260
Mailing Address - Country:US
Mailing Address - Phone:575-523-6554
Mailing Address - Fax:575-523-5357
Practice Address - Street 1:4351 E LOHMAN AVE STE 208
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8260
Practice Address - Country:US
Practice Address - Phone:575-523-6554
Practice Address - Fax:575-523-5357
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170523363L00000X
NMCNP-2403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09685758Medicaid
CO0306446Medicare PIN
COP00825877Medicare PIN