Provider Demographics
NPI:1437369071
Name:SHUPE, ROBERTA J (RN)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
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 1:215 3RD ST SW
Mailing Address - Street 2:BOX 1076
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526
Mailing Address - Country:US
Mailing Address - Phone:406-353-2590
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 67
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9705
Practice Address - Country:US
Practice Address - Phone:406-353-3100
Practice Address - Fax:406-353-3229
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN 14698163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTRN 14698OtherLICENSE