Provider Demographics
NPI:1508219130
Name:SHUPE, ASHLEY (RN)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SHUPE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 HOFFMAN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8769
Mailing Address - Country:US
Mailing Address - Phone:253-348-3569
Mailing Address - Fax:
Practice Address - Street 1:3088 HOFFMAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-8769
Practice Address - Country:US
Practice Address - Phone:253-348-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60642403163W00000X
NE51905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse