MEDICARE: MARILYNN M. SHAW MS, APRN, NP, CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95009825	CA

General Provider Information

NPI Number	:	1114400967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYNN M. SHAW MS, APRN, NP, CNS

Provider Business Mailing Address
First Line	:	3927 WARING RD STE C
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4458
Country	:	US
Telephone Number	:	619-703-7220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3927 WARING RD STE C
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4458
Country	:	US
Telephone Number	:	619-703-7220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	12/18/2025

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