Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 12595 | CA |
NPI | 1073641643 |
---|---|
Provider Name | Ms. Heather Catherine Shaw |
First Address | Palo Alto, CA 94303-3341 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 14/10/2016 |