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NPI Code Detail

MEDICARE: MRS. DANELLE KRISTINE SHAW RN

MEDICARE: MRS. DANELLE KRISTINE SHAW RN
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
1163W00000XRegistered Nurse4704298995MI

General Provider Information

NPI Number : 1194184093
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DANELLE KRISTINE SHAW RN
Provider Business Mailing Address
First Line : 2201 S GETTY ST
Second Line :
City : MUSKEGON HEIGHTS
State : MI
Zip : 49444-1207
Country : US
Telephone Number : 231-739-9315
Fax Number :
Provider Business Practice Location Address
First Line : 2201 S GETTY ST
Second Line :
City : MUSKEGON HEIGHTS
State : MI
Zip : 49444-1207
Country : US
Telephone Number : 231-739-9315
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2016
Last Update Date : 02/19/2016

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