Provider Demographics
NPI:1003213901
Name:SHIPLEY, ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S 1300 W
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3761
Mailing Address - Country:US
Mailing Address - Phone:385-440-1400
Mailing Address - Fax:801-845-9965
Practice Address - Street 1:360 S 1300 W
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3761
Practice Address - Country:US
Practice Address - Phone:385-440-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013990363L00000X
UT11193762-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP013990OtherCRNP FAMILY HEALTH