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General NPI Number Information
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NPI Number | 1760267785
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Entity Type | Individual
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Provider Name | DOMINIQUE NICOLE SHAW WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 26005 RIDGE RD STE 200
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City | DAMASCUS
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State | MD
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Zip | 20872-1899
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Country | US
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Telephone | 301-414-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 13909 FLOYD ST
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-6844
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Country | US
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Telephone | 240-274-4692
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | R224771
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License Number State | MD
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