1376675249 NPI number — MRS. NANCY ANITA PERRY SHIPP P.T.

Table of content: MRS. NANCY ANITA PERRY SHIPP P.T. (NPI 1376675249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376675249 NPI number — MRS. NANCY ANITA PERRY SHIPP P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIPP
Provider First Name:
NANCY
Provider Middle Name:
ANITA PERRY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERRY
Provider Other First Name:
NANCY
Provider Other Middle Name:
ANITA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376675249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5351 HESPERUS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21044-1838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-245-5235
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PMRS, AVE D, BUILDING 23H, GROUND FLOOR
Provider Second Line Business Practice Location Address:
VETERANS ADMINISTRATION MARYLAND HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
PERRY POINT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-642-2411
Provider Business Practice Location Address Fax Number:
410-642-1052
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  19715 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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