MEDICARE: MS. BARBARA SHAW APN

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	209001421	IL

General Provider Information

NPI Number	:	1962442608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA SHAW APN

Provider Business Mailing Address
First Line	:	1128 N MOZART ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2718
Country	:	US
Telephone Number	:	773-235-7036
Fax Number	:	773-235-7036

Provider Business Practice Location Address
First Line	:	845 S DAMEN AVE
Second Line	:	INTEGRATED HEALTH CARE, UIC COLLEGE OF NURSING, 9TH FL.
City	:	CHICAGO
State	:	IL
Zip	:	60612-3727
Country	:	US
Telephone Number	:	773-537-3950
Fax Number	:	773-435-0119

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/25/2012

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