Provider Demographics
NPI:1225500309
Name:ALSUP, SHIRLEY ANN (MSN, CCRN, CNS, APRN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:ALSUP
Suffix:
Gender:F
Credentials:MSN, CCRN, CNS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6722 STATE ROUTE 132
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-9249
Mailing Address - Country:US
Mailing Address - Phone:513-575-7879
Mailing Address - Fax:513-456-2855
Practice Address - Street 1:6722 STATE ROUTE 132
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9249
Practice Address - Country:US
Practice Address - Phone:513-575-7879
Practice Address - Fax:513-456-2855
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-29
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.155963163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty