Healthcare Provider Details

I. General information

NPI: 1730165473
Provider Name (Legal Business Name): JULIE KAY SHAW ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE
CEDAR RAPIDS IA
52402-5036
US

IV. Provider business mailing address

PO BOX 3026 1026 A AVE NE
CEDAR RAPIDS IA
52406-3026
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7211
  • Fax: 319-861-6768
Mailing address:
  • Phone: 319-369-7211
  • Fax: 319-861-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberH092499
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: