Provider Demographics
NPI:1184472631
Name:SHIPLETTE, JOHN II
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHIPLETTE
Suffix:II
Gender:M
Credentials:
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 876646
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6646
Mailing Address - Country:US
Mailing Address - Phone:907-717-9485
Mailing Address - Fax:
Practice Address - Street 1:7335 E PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7710
Practice Address - Country:US
Practice Address - Phone:907-745-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health