Healthcare Provider Details

I. General information

NPI: 1982968103
Provider Name (Legal Business Name): NORA K SHUMWAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201BJC ST. PETERS DR SUITE 1A
SAINT PETERS MO
63376-3385
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 636-277-0073
  • Fax: 636-277-0074
Mailing address:
  • Phone: 866-630-9882
  • Fax: 920-682-5810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2016011558
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: