Provider Demographics
NPI:1184963712
Name:SHIPMAN, DEANNA MARIE
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:MARIE
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-2730
Mailing Address - Country:US
Mailing Address - Phone:518-310-1768
Mailing Address - Fax:
Practice Address - Street 1:7 RIVERS EDGE DR
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-2730
Practice Address - Country:US
Practice Address - Phone:518-310-1768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309975-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse