Provider Demographics
NPI:1447844089
Name:SHAW, MICHAEL GERARD RICHARD (RN, APRN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GERARD RICHARD
Last Name:SHAW
Suffix:
Gender:M
Credentials:RN, APRN
Other - Prefix:
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Mailing Address - Street 1:315 TRESTLE DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-5806
Mailing Address - Country:US
Mailing Address - Phone:313-529-5975
Mailing Address - Fax:
Practice Address - Street 1:5325 ELLIOTT DR FL 2
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-8000
Practice Address - Fax:734-712-8010
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704278668163WF0300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WF0300XNursing Service ProvidersRegistered NurseFlight