Ethan John Shaw, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN271630 Issued in PA

Practice address

438 Student Health Ctr
University Park, PA 16802-2129

Phone

(814) 863-0774

NPI assigned

Oct 24, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Pennsylvania State University

  dba University Health Services

  • Family Medicine Physician
  • University Park, PA
  • NPI 1316063126
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508803200000",
    "number": "1346751823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 ARC RD",
            "city": "WEST DECATUR",
            "state": "PA",
            "postal_code": "168788540",
            "telephone_number": "814-592-8509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 STUDENT HEALTH CTR",
            "city": "UNIVERSITY PARK",
            "state": "PA",
            "postal_code": "168022129",
            "telephone_number": "814-863-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "ETHAN",
        "middle_name": "JOHN",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-24",
        "last_updated": "2017-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN271630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeleine Scaramuzzo, MS, ATC, LAT, PES
• Ashley Lyn Schrag, LPC
• Janea E. Schreckengost, PA-C
• Elizabeth Serpas
• Ann Shallcross, M.D.
• Heather A Shevchik O'Brien, PA-C
• Linda Schmalstieg Shorey, CRNP
• Arizona Shreck
• Kimberly Shuey, LPN
• Paula Andrea Siaca Meza

• Licensed Practical Nurse in University Park, PA
• Providers in University Park, PA by specialty
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.