Provider Demographics
NPI:1013583764
Name:SHUPE, HEATHER R (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:SHUPE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13642 KLOPFENSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-9278
Mailing Address - Country:US
Mailing Address - Phone:419-819-7355
Mailing Address - Fax:
Practice Address - Street 1:13642 KLOPFENSTEIN RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-9278
Practice Address - Country:US
Practice Address - Phone:419-819-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN349192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty