Provider Demographics
NPI:1225457062
Name:SHUPING, PATRICIA MICHAELIS (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MICHAELIS
Last Name:SHUPING
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 1:1931 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-5482
Mailing Address - Country:US
Mailing Address - Phone:843-915-8749
Mailing Address - Fax:843-915-6506
Practice Address - Street 1:1931 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5482
Practice Address - Country:US
Practice Address - Phone:843-915-8749
Practice Address - Fax:843-915-6506
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR25866163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health