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General NPI Number Information
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NPI Number | 1417766973
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Entity Type | Individual
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Provider Name | RICKI MARITA SHAW ACNP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 2106 WOODRUFF RD
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City | GREENVILLE
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State | SC
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Zip | 29607-6944
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Country | US
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Telephone | 864-520-9115
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Fax |
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Provider Business Mailing Address
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Address Line | 2 FURMAN ST
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City | GREENVILLE
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State | SC
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Zip | 29611-4709
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Country | US
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Telephone | 864-520-3054
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 29614
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License Number State | SC
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