Provider Demographics
NPI:1881861250
Name:SHUPE, MARY A (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:SHUPE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 N MINNESOTA ST
Mailing Address - Street 2:PO BOX 924
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-1728
Mailing Address - Country:US
Mailing Address - Phone:507-359-2756
Mailing Address - Fax:507-354-1260
Practice Address - Street 1:6 N MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1728
Practice Address - Country:US
Practice Address - Phone:507-359-2756
Practice Address - Fax:507-354-1260
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR161729-8163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health