| NPI | 1437638830 |
|---|---|
| Former Name | LORI L SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WI 8742-33) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WI 135949) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-10-15 |