MEDICARE: TANYA LOY 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
1	163W00000X	Registered Nurse	68784	NE

General Provider Information

NPI Number	:	1477071058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA LOY SHAW RN

Provider Business Mailing Address
First Line	:	7911 MYRTLE ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-3154
Country	:	US
Telephone Number	:	402-416-0034
Fax Number	:

Provider Business Practice Location Address
First Line	:	7911 MYRTLE ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68506-3154
Country	:	US
Telephone Number	:	402-416-0034
Fax Number	:

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	07/21/2022

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