Provider Demographics
NPI:1356662605
Name:SHIPMAN, MEAGAN ALISE (RN)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:ALISE
Last Name:SHIPMAN
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 1:597 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3508
Mailing Address - Country:US
Mailing Address - Phone:210-415-4415
Mailing Address - Fax:
Practice Address - Street 1:597 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3508
Practice Address - Country:US
Practice Address - Phone:210-415-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX773577163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse