Provider Demographics
NPI:1003405739
Name:SHAW, REBECCA ANNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:SHAW
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1131 S PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3062
Mailing Address - Country:US
Mailing Address - Phone:480-296-4742
Mailing Address - Fax:480-805-2184
Practice Address - Street 1:1140 E GREENWAY ST STE 1
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-4359
Practice Address - Country:US
Practice Address - Phone:480-296-4742
Practice Address - Fax:480-805-2184
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ262350363LP0808X
AZRN171736163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)