Provider Demographics
NPI:1861826430
Name:SHIPTOSKI, BRIAN D (CRNP)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
Last Name:SHIPTOSKI
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:SCI-MUNCY
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756
Mailing Address - Country:US
Mailing Address - Phone:570-546-3171
Mailing Address - Fax:
Practice Address - Street 1:6454 RT 405 HWY
Practice Address - Street 2:SCI-MUNCY
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756
Practice Address - Country:US
Practice Address - Phone:570-546-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily