Provider Demographics
NPI:1265709794
Name:SHIPP, SHYANNE ROSELYNN (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:SHYANNE
Middle Name:ROSELYNN
Last Name:SHIPP
Suffix:
Gender:F
Credentials:RN, IBCLC
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 579
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0579
Mailing Address - Country:US
Mailing Address - Phone:580-745-5228
Mailing Address - Fax:580-920-9976
Practice Address - Street 1:1706 DELIVERY LN
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2292
Practice Address - Country:US
Practice Address - Phone:580-745-5228
Practice Address - Fax:580-920-9976
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92357163WL0100X
TX772299163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant