1972945798 NPI number — MRS. GRACE MARIE SHIPLEY PN-132199-MEDS

Table of content: MRS. GRACE MARIE SHIPLEY PN-132199-MEDS (NPI 1972945798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972945798 NPI number — MRS. GRACE MARIE SHIPLEY PN-132199-MEDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIPLEY
Provider First Name:
GRACE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PN-132199-MEDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRYE
Provider Other First Name:
GRACE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PN-132199-MEDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1972945798
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1770 FORMAN RD
Provider Second Line Business Mailing Address:
APT A
Provider Business Mailing Address City Name:
AUSTINBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44010-9720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-855-8130
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1770 FORMAN RD
Provider Second Line Business Practice Location Address:
APT A
Provider Business Practice Location Address City Name:
AUSTINBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44010-9720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-855-8130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2013

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: 164W00000X , with the licence number:  PN132199 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com