MEDICARE: MS. ANN LOUISE SHAH NP

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	303810	CA

General Provider Information

NPI Number	:	1386625887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN LOUISE SHAH NP

Provider Business Mailing Address
First Line	:	10452 SHADYRIDGE DR
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-1587
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 W LA PALMA AVE
Second Line	:	#7
City	:	ANAHEIM
State	:	CA
Zip	:	92801-2821
Country	:	US
Telephone Number	:	714-956-9201
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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