Provider Demographics
NPI:1588785414
Name:SHAW, CYNTHIA ANN (MSN, CNM, APRN)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:MSN, CNM, APRN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, APRN
Mailing Address - Street 1:703 BENDELOW DR
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-5015
Mailing Address - Country:US
Mailing Address - Phone:501-690-3081
Mailing Address - Fax:479-525-5963
Practice Address - Street 1:703 BENDELOW DR
Practice Address - Street 2:
Practice Address - City:CAVE SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72718-5015
Practice Address - Country:US
Practice Address - Phone:501-690-3081
Practice Address - Fax:479-525-5963
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM01007363LW0102X, 363L00000X
ARM01007CNM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134857799OtherTRICARE PROVIDER NUMBER
AR134857799Medicaid
AR5U052Medicare ID - Type Unspecified