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General NPI Number Information
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NPI Number | 1003405739
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Entity Type | Individual
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Provider Name | REBECCA ANNE SHAW PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 1140 E GREENWAY ST STE 1
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City | MESA
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State | AZ
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Zip | 85203-4359
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Country | US
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Telephone | 480-296-4742
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Fax | 480-805-2184
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Provider Business Mailing Address
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Address Line | 1131 S PHEASANT DR
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City | GILBERT
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State | AZ
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Zip | 85296-3062
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Country | US
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Telephone | 480-296-4742
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Fax | 480-805-2184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 262350
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License Number State | AZ
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