MEDICARE: KARA LYNNE 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	163WG0000X	General Practice Registered Nurse	587737	CA

General Provider Information

NPI Number	:	1679031173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA LYNNE SHAW RN

Provider Business Mailing Address
First Line	:	9401 WANDERING OAK DR
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93311-1622
Country	:	US
Telephone Number	:	661-204-2183
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 CALIFORNIA AVE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-7024
Country	:	US
Telephone Number	:	661-630-7046
Fax Number	:

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

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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