Provider Demographics
NPI:1720591936
Name:SHUPP, CORINTHIA (APRN)
Entity Type:Individual
Prefix:
First Name:CORINTHIA
Middle Name:
Last Name:SHUPP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CORINTHIA
Other - Middle Name:
Other - Last Name:NIEDERMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SC HOUSE CALLS INC
Mailing Address - Street 2:111 DOCTORS CIRCLE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:
Practice Address - Street 1:SC HOUSE CALLS INC
Practice Address - Street 2:111 DOCTORS CIRCLE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.021805364SF0001X
SC26637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health