MEDICARE: ANGELA MAE SHAW

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	RN. 299811	OH
2	163WH0200X	Home Health Registered Nurse	RN. 299811	OH

General Provider Information

NPI Number	:	1881925923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MAE SHAW

Provider Business Mailing Address
First Line	:	224 HARMON ST SW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-3063
Country	:	US
Telephone Number	:	330-309-7596
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 HARMON ST SW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-3063
Country	:	US
Telephone Number	:	330-309-7596
Fax Number	:

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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Directions to “ ANGELA MAE SHAW ” Practice Location

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