Provider Demographics
NPI:1972945798
Name:SHIPLEY, GRACE MARIE (PN-132199-MEDS)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARIE
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:PN-132199-MEDS
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MARIE
Other - Last Name:FRYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PN-132199-MEDS
Mailing Address - Street 1:1770 FORMAN RD
Mailing Address - Street 2:APT A
Mailing Address - City:AUSTINBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44010-9720
Mailing Address - Country:US
Mailing Address - Phone:440-855-8130
Mailing Address - Fax:
Practice Address - Street 1:1770 FORMAN RD
Practice Address - Street 2:APT A
Practice Address - City:AUSTINBURG
Practice Address - State:OH
Practice Address - Zip Code:44010-9720
Practice Address - Country:US
Practice Address - Phone:440-855-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN132199164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse