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General NPI Number Information
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NPI Number | 1982118220
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Entity Type | Individual
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Provider Name | JILLIAN DENISE SHAW NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2017
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Last Update Date | 04/20/2020
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Provider Practice Location Address
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Address Line | 400 E BUSINESS WAY
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City | SHARONVILLE
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State | OH
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Zip | 45241-3089
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Country | US
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Telephone | 952-687-4088
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Fax |
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Provider Business Mailing Address
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Address Line | 7450 SILVER LAKE DR
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City | WAYNESVILLE
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State | OH
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Zip | 45068-8230
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Country | US
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Telephone | 937-903-4442
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.022082
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License Number State | OH
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