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General NPI Number Information
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NPI Number | 1487504130
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Entity Type | Individual
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Provider Name | HEATHER MARIE SHAW
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Gender | Female
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 113 S 2400 RD
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City | WHITE CITY
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State | KS
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Zip | 66872-9373
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Country | US
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Telephone | 785-512-0402
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Fax |
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Provider Business Mailing Address
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Address Line | 321 W KANSAS ST
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City | WHITE CITY
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State | KS
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Zip | 66872-9329
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Country | US
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Telephone | 785-226-1534
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | KS
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