Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 221810 | AZ |
N | 363LA2200X | Nurse Practitioner - Adult Health | 221810 | AZ |
N | 363LG0600X | Nurse Practitioner - Gerontology | 221810 | AZ |
NPI | 1013471309 |
---|---|
Provider Name | Anthony James Shaw |
First Address | Glendale, AZ 85303-7606 |
Second Address | Glendale, AZ 85303-7606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2019 |
Last Update Date | 30/01/2019 |