Provider Demographics
NPI:1023812534
Name:SHAW, KAYLEE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:NICOLE
Last Name:SHAW
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 FAIRVIEW LN
Mailing Address - Street 2:PO BOX 467
Mailing Address - City:KELLEYS ISLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43438
Mailing Address - Country:US
Mailing Address - Phone:419-934-1240
Mailing Address - Fax:
Practice Address - Street 1:131 FAIRVIEW LN
Practice Address - Street 2:PO BOX 467
Practice Address - City:KELLEYS ISLAND
Practice Address - State:OH
Practice Address - Zip Code:43438
Practice Address - Country:US
Practice Address - Phone:419-934-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.531363163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse