| NPI | 1366107526 |
|---|---|
| Former Name | KATELYN NICOLE SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 17321-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 102711-875) |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2021040572) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-09-12 |