Provider Demographics
NPI:1770682346
Name:SHOUP, DANA LINDGREN (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:LINDGREN
Last Name:SHOUP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E JEFFERSON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5353
Mailing Address - Country:US
Mailing Address - Phone:434-227-5624
Mailing Address - Fax:434-970-7700
Practice Address - Street 1:1101 E JEFFERSON ST STE 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5353
Practice Address - Country:US
Practice Address - Phone:434-227-5624
Practice Address - Fax:434-977-7700
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1770682346OtherNPI