MEDICARE: MS. ERIN RUTLEDGE SHAW FNP-C

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	AP136922	TX

General Provider Information

NPI Number	:	1609378454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN RUTLEDGE SHAW FNP-C

Provider Business Mailing Address
First Line	:	245 LAUREN DR
Second Line	:
City	:	ORANGE
State	:	TX
Zip	:	77630-2443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	882 SIERRA DR
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5607
Country	:	US
Telephone Number	:	409-722-1234
Fax Number	:	877-831-8991

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	08/07/2019

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