| NPI | 1427055334 |
|---|---|
| Former Name | JACQUELINE G SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 622) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 001095) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-11-22 |