MEDICARE: COURTNEY ELIZABETH SHAW CNP

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	8646	MN

General Provider Information

NPI Number	:	1487316840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ELIZABETH SHAW CNP

Provider Business Mailing Address
First Line	:	1001 E SUPERIOR ST STE 201
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2228
Country	:	US
Telephone Number	:	218-249-3852
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E SUPERIOR ST STE 201
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2228
Country	:	US
Telephone Number	:	218-249-3852
Fax Number	:

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

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	12/15/2021

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