Provider Demographics
NPI:1730165473
Name:SHAW, JULIE KAY (ARNP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:SHAW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3026
Mailing Address - Street 2:1026 A AVE NE
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3026
Mailing Address - Country:US
Mailing Address - Phone:319-369-7211
Mailing Address - Fax:319-861-6768
Practice Address - Street 1:1026 A AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5036
Practice Address - Country:US
Practice Address - Phone:319-369-7211
Practice Address - Fax:319-861-6768
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH092499363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAQ56897Medicare UPIN
IAI16500Medicare ID - Type Unspecified