Provider Demographics
NPI:1548467921
Name:SHAW, JANEILLE SUE (NP)
Entity type:Individual
Prefix:MRS
First Name:JANEILLE
Middle Name:SUE
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JANEILLE
Other - Middle Name:SUE
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 9247
Mailing Address - Street 2:ONE MEDICAL CENTER DRIVE
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9247
Mailing Address - Country:US
Mailing Address - Phone:304-293-2311
Mailing Address - Fax:304-293-2713
Practice Address - Street 1:9247 STUDENT HEALTH SERVICE
Practice Address - Street 2:ROBERT C. BYRD HEALTH SCIENCES CENTER
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9247
Practice Address - Country:US
Practice Address - Phone:304-293-2311
Practice Address - Fax:304-293-2713
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily