Provider Demographics
NPI:1558546747
Name:SHIPPERT, MICHELLE NICOLE STALTER (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NICOLE STALTER
Last Name:SHIPPERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3058
Mailing Address - Country:US
Mailing Address - Phone:814-237-0001
Mailing Address - Fax:
Practice Address - Street 1:1526 MARTIN ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3058
Practice Address - Country:US
Practice Address - Phone:814-237-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 014984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine