Provider Demographics
NPI:1366465338
Name:UPSHAW, NANCEY WHITEHILL (LYNNE) (LMT)
Entity Type:Individual
Prefix:MRS
First Name:NANCEY
Middle Name:WHITEHILL (LYNNE)
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S MARION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-7065
Mailing Address - Country:US
Mailing Address - Phone:386-758-3577
Mailing Address - Fax:386-758-3577
Practice Address - Street 1:323 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-7065
Practice Address - Country:US
Practice Address - Phone:386-758-3577
Practice Address - Fax:386-758-3577
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA31532225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC9970OtherBCBS PROVIDER NUMBER