MANDIE L SHAW (NPI# 1114475332) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114475332 |
| Entity Type | Individual |
| Full Name | MANDIE L SHAW |
| Credential | CRNP |
| Practice Address |
1930 Cliffside Dr State College PA 16801-7662 |
| Practice Telephone | 9736618300 |
| Practice Fax Number | 9736618333 |
| Mailing Telephone | 8148261149 |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2020-09-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
SP016588 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1555 Shawna Rd, Cherry Tree, PA 157249003 | 8147435449 |
| Street Address |
1930 CLIFFSIDE DR |
| City | STATE COLLEGE |
| State | PA |
| Zip Code | 16801-7662 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477920569 | Justine Shaner | Physical Therapy Assistant | 1930 Cliffside Dr, State College, PA 16801-7662 | 2015-08-25 |
| 1902253420 | Jenny L. Knecht | Registered Nurse | 1930 Cliffside Dr, State College, PA 16801-7662 | 2016-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851880975 | Creative Reflections Counseling, LLC | Counselor | 315 S Allen St Ste 124b, State College, PA 16801 | 2018-05-03 |
| 1679097901 | Michelle L Grove | Home Health Aide | 2100 E College Ave Ste B, State College, PA 16801 | 2017-07-28 |
| 1740702034 | Matthew Ishler | Counselor | 315 S. Allen Street Ste 326, State College, PA 16801 | 2017-07-09 |
| 1699206300 | Emily Lauer | Specialist/Technologist | 102a Multisport Indoor Facility, State College, PA 16801 | 2017-03-23 |
| 1740721075 | Luk Devorski | Student in an Organized Health Care Education/Training Program | Rec Hall University Park, Penn State University, State College, PA 16801 | 2017-03-20 |
| 1013465764 | Pennsylvania Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 201 West Beaver Avenue, State College, PA 16801 | 2016-09-12 |
| 1740685858 | Mallory L. Miller | Physician Assistant | 100 Radnor Rd Ste 101, State College, PA 16801 | 2014-10-31 |
| 1386053981 | Christopher Hippenmeyer | Specialist/Technologist | 102a East Area Locker Building, Pennsylvania State University, University Park, PA 16801 | 2014-08-07 |
| 1982022059 | Christy Sharer | Counselor | 301 S Allen St Ste 106, State College, PA 16801 | 2014-04-04 |
| 1912250523 | Eva M Letwin | Counselor | 2011 Cato Ave Ste 201, State College, PA 16801 | 2012-10-19 |
| Find all providers in zip 16801 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124395215 | Michelle Lynn Fanning-hursh | Nurse Practitioner | 200 W Beaver Ave Ste 100, State College, PA 16801-4820 | 2011-11-17 |
| 1659536654 | Geraldine M Budd | Nurse Practitioner | 2440 Chatham Ct, State College, PA 16803-2401 | 2008-07-20 |
| 1245210541 | Tracey Allen Banks | Nurse Practitioner | 211 Noll Lab, State College, PA 16802 | 2006-01-20 |
| 1740264092 | Marykathryn Corcoran | Nurse Practitioner | 315 South Allen St., Suite 417-a, State College, PA 16801 | 2005-11-30 |
| 1891320941 | Jill Nicole Sathish | Nurse Practitioner | 32 Colonnade Way, State College, PA 16803-2309 | 2020-03-10 |
| 1255975892 | Lauren B Davidson | Nurse Practitioner | 905 University Dr, State College, PA 16801-6626 | 2019-11-06 |
| 1821631631 | Amber Renee Morrow | Nurse Practitioner | 2520 Green Tech Dr Ste C, State College, PA 16803-2308 | 2019-10-24 |
| 1366948192 | Janet R Cady | Nurse Practitioner | 1850 E Park Ave Ste 201, State College, PA 16803 | 2018-04-02 |
| 1023524501 | Melissa Ann Wallace | Nurse Practitioner | 905 University Dr, State College, PA 16801-6626 | 2017-12-20 |
| 1124533138 | Caitlin J Fernandez | Nurse Practitioner | 905 University Dr, State College, PA 16801-6626 | 2017-12-13 |
| Find all providers in STATE COLLEGE | ||||
| City | STATE COLLEGE |
| Zip Code | 16801 |
Please comment or provide details below to improve the information on MANDIE L SHAW.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.