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NPI Code Detail

MEDICARE: ANNA SHAW

MEDICARE: ANNA SHAW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1164836961
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA SHAW
Provider Business Mailing Address
First Line : PO BOX 2168
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-2168
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 N FRANKLIN ST
Second Line :
City : FORT BRAGG
State : CA
Zip : 95437-3602
Country : US
Telephone Number : 707-961-0172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2014
Last Update Date : 07/12/2016

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Directions to “ ANNA SHAW ” Practice Location

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