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General NPI Number Information
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NPI Number | 1376405936
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Entity Type | Individual
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Provider Name | JAELYN SHAW RN
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Gender | Female
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 187 HOSPITAL DR
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City | TYRONE
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State | PA
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Zip | 16686-1808
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Country | US
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Telephone | 814-684-1255
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Fax |
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Provider Business Mailing Address
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Address Line | 3340 UTAHVILLE RD
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City | COALPORT
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State | PA
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Zip | 16627-9360
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Country | US
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Telephone | 814-330-1683
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Fax |
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN804122
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License Number State | PA
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