Provider Demographics
NPI:1871545905
Name:TURNEY-SHAW, JEAN R (FNP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:R
Last Name:TURNEY-SHAW
Suffix:
Gender:F
Credentials:FNP
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 1508
Mailing Address - Street 2:
Mailing Address - City:CLAYPOOL
Mailing Address - State:AZ
Mailing Address - Zip Code:85532-1508
Mailing Address - Country:US
Mailing Address - Phone:928-402-0952
Mailing Address - Fax:928-425-7566
Practice Address - Street 1:108 S BROAD ST
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2602
Practice Address - Country:US
Practice Address - Phone:928-425-6592
Practice Address - Fax:928-425-7566
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1205962792OtherNPI MEDCOM MEDICAL, LLC
AZZ71760OtherMEDCOM MEDICAL, LLC PTAN#
AZZ158196OtherMEDICARE PTAN
AZQ08431OtherMEDICARE
AZ1871545905OtherNPI JEAN TURNEY-SHAW
AZ840985Medicaid
AZ78020Medicare ID - Type Unspecified