Provider Demographics
NPI:1366894677
Name:SHIPE, MARTHA G (CNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:G
Last Name:SHIPE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:G
Other - Last Name:WARTINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5308 HARROUN RD STE 55
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2174
Mailing Address - Country:US
Mailing Address - Phone:419-824-6599
Mailing Address - Fax:419-882-3870
Practice Address - Street 1:5308 HARROUN RD STE 55
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2174
Practice Address - Country:US
Practice Address - Phone:419-824-6599
Practice Address - Fax:419-882-3870
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366894677Medicaid
OH0176934Medicaid