Annetta M Shaw, RN,BSN,CRNFA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

3807 Greenleaf Ave NW
Bemidji, MN 56601-5817

Phone

(218) 751-9746

Fax

(218) 759-0620

NPI assigned

Jan 25, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770639635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3807 GREENLEAF AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015817",
            "telephone_number": "218-751-9746",
            "fax_number": "218-759-0620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3807 GREENLEAF AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566015817",
            "telephone_number": "218-751-9746",
            "fax_number": "218-759-0620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "ANNETTA",
        "middle_name": "M",
        "credential": "RN,BSN,CRNFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "85G67SH",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFFEREDONE",
            "identifier": "855911029535",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Severts, CNP
• Alexis June Sewall
• Mark A Shanfeld, M.D.
• McKenna Mohr Shanfeld
• Aviskar Sharma
• Raymond Carl Shefland
• Sheridan Anesthesia Services of Minnesota, PC
• Olumayowa Beatrice Sholola, MD
• Jayten Shook, D.O.; MS
• Shoptikal LLC

• Surgical Physician Assistant in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Surgical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.