Provider Demographics
NPI:1023641743
Name:SHAW, JONATHAN (PMHNP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1309 COFFEEN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5777
Mailing Address - Country:US
Mailing Address - Phone:888-985-4287
Mailing Address - Fax:541-632-4858
Practice Address - Street 1:1755 COBURG RD UNIT 301
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4900
Practice Address - Country:US
Practice Address - Phone:888-468-9669
Practice Address - Fax:541-632-4858
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95017588363LP0808X
NV836571363LP0808X
WY47689363LP0808X
WAAP61160807363LP0808X
OR202108944NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health