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General NPI Number Information
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NPI Number | 1609490382
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Entity Type | Individual
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Provider Name | BROOKE MARTIN SHAW DNP, APRN, AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 5514, 350 N COX ST STE 6
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City | ASHEBORO
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State | NC
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Zip | 27203
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Country | US
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Telephone | 336-629-2201
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 BOLINGBROKE RD
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City | HIGH POINT
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State | NC
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Zip | 27265-2426
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Country | US
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Telephone | 704-880-3665
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 246993
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License Number State | NC
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