Shaw, Kimberly Danielle

Shaw, Kimberly Danielle is an individual health care provider with primary practice located at 31 W 155Th St , Harvey IL 60426-3556. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Shaw, Kimberly Danielle can be contacted via phone (708) 596-5177.

Contact Information

Primary practice address
31 W 155Th St Harvey IL 60426-3556
Phone: (708) 596-5177
Fax: (708) 596-5518
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 085-003355 Illinois

Profile Details

NPI number 1942454186
LBN Legal business name Shaw, Kimberly Danielle
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2008
Last updated Jul 18th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942454186 NPPES
Illinois MEDICAID 085003355
Illinois Other 01616617

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