Provider Demographics
NPI:1235344391
Name:POPPE, SHAWNTEE JANE (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNTEE
Middle Name:JANE
Last Name:POPPE
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14991 CHARMHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365
Mailing Address - Country:US
Mailing Address - Phone:937-498-9805
Mailing Address - Fax:937-498-9805
Practice Address - Street 1:14991 CHARMHILL DRIVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365
Practice Address - Country:US
Practice Address - Phone:937-498-9805
Practice Address - Fax:937-498-9805
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2545213374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide