Basic Information
| Provider Information | |||||||||
| NPI: | 1770503666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAW-BATTISTA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PHD, RN, NP, CNM, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1113 OESTE DR | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956161850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302203107 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2051 JOHN JONES RD | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956169701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307582060 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 06/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN557883 | CA | N | Nursing Service Providers | Registered Nurse | 363LW0102X | NP12711 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | NMF1510 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | RN557883 | 05 | CA | MEDICAID |