Healthcare Provider Details

I. General information

NPI: 1285573808
Provider Name (Legal Business Name): WHITNEY CARTER SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 NM 605 #3626
MILAN NM
87021
US

IV. Provider business mailing address

PO BOX 3626
MILAN NM
87021-3626
US

V. Phone/Fax

Practice location:
  • Phone: 719-480-3864
  • Fax:
Mailing address:
  • Phone: 719-480-3864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-88383
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: