Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 9855PT | AZ |
NPI | 1033474432 |
---|---|
Provider Name | Mrs. Ashlee Marie Shupe |
First Address | Eugene, OR 97401-6021 |
Second Address | Eugene, OR 97401-6021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 09/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12409672 | CAQH (01) | AZ |