Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 286382 | NY |
N | 363LS0200X | School | 286382 | NY |
NPI | 1043631278 |
---|---|
Provider Name | Beverly Ann Shipe |
First Address | Williamsville, NY 14221-5018 |
Second Address | Williamsville, NY 14221-5018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2013 |
Last Update Date | 16/02/2015 |