Provider Demographics
NPI:1942203492
Name:SHAW, JULIE K (PA)
Entity type:Individual
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First Name:JULIE
Middle Name:K
Last Name:SHAW
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2115 N KANSAS AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2640
Mailing Address - Country:US
Mailing Address - Phone:402-463-6828
Mailing Address - Fax:402-463-4767
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:STE 103
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2640
Practice Address - Country:US
Practice Address - Phone:402-463-6828
Practice Address - Fax:402-463-4767
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2013-05-14
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063717813Medicaid