Provider Demographics
NPI:1871180166
Name:SHAW, REBEKAH SUZANNE (NP-C)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:SUZANNE
Last Name:SHAW
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HWY 90 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3876
Mailing Address - Country:US
Mailing Address - Phone:979-256-1652
Mailing Address - Fax:979-256-1620
Practice Address - Street 1:2006 HWY 90 W
Practice Address - Street 2:SUITE C
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3876
Practice Address - Country:US
Practice Address - Phone:979-256-1652
Practice Address - Fax:979-256-1620
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1022825OtherAPRN