Provider Demographics
NPI:1740276070
Name:WEISHEIPL, SHELLY J (CNM)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:J
Last Name:WEISHEIPL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 W MIFFLIN ST APT 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-2629
Mailing Address - Country:US
Mailing Address - Phone:920-420-3977
Mailing Address - Fax:
Practice Address - Street 1:619 W MIFFLIN ST APT 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2629
Practice Address - Country:US
Practice Address - Phone:920-420-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87389367A00000X, 367A00000X
NC456367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
S20624Medicare UPIN