Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 139217 | MO |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 139217 | MO |
NPI | 1982714853 |
---|---|
Provider Name | Daniel Shipp |
First Address | Wentzville, MO 63385-3438 |
Second Address | Wentzville, MO 63385-3438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 27/02/2008 |