Provider Demographics
NPI:1447665237
Name:SHAW, CHERESE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CHERESE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:APRN, FNP-BC
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 3238
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0055
Mailing Address - Country:US
Mailing Address - Phone:956-618-3979
Mailing Address - Fax:956-618-3975
Practice Address - Street 1:833 W DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3508
Practice Address - Country:US
Practice Address - Phone:956-618-3979
Practice Address - Fax:956-618-3975
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX772364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX627852YVDAOtherMEDICARE