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General NPI Number Information
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NPI Number | 1972256329
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Entity Type | Individual
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Provider Name | MS. REANA SHAW
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Gender | Female
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 3759 N 88TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-2729
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Country | US
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Telephone | 414-975-2334
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Fax |
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Provider Business Mailing Address
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Address Line | 10936 N PORT WASHINGTON RD # 121
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City | MEQUON
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State | WI
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Zip | 53092-5031
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Country | US
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Telephone | 414-975-2334
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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 | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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