Provider Demographics
NPI:1588935795
Name:SHAW, CHRISTOPHER G (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:SHAW
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:859-433-8099
Mailing Address - Fax:
Practice Address - Street 1:100 E LIBERTY ST
Practice Address - Street 2:SUITE 800
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1434
Practice Address - Country:US
Practice Address - Phone:502-540-3365
Practice Address - Fax:502-479-1425
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007295367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100187650Medicaid