MEDICARE: CHRISTINE R SHAW PHD, APRN-BC

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
1	363LF0000X	Family Nurse Practitioner	55699-030	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295738581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE R SHAW PHD, APRN-BC

Provider Business Mailing Address
First Line	:	2353 N LEFEBER AVE
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1217
Country	:	US
Telephone Number	:	414-288-3843
Fax Number	:	414-288-1939

Provider Business Practice Location Address
First Line	:	MARQUETTE CLINIC FOR WOMEN AND CHILDREN
Second Line	:	530 N. 16TH ST.
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-1881
Country	:	US
Telephone Number	:	414-345-3250
Fax Number	:	414-345-3249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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