Provider Demographics
NPI:1114353471
Name:SHIPLEY, JACLYN BENTHALL (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:BENTHALL
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 271647
Mailing Address - Street 2:UNC FP
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1647
Mailing Address - Country:US
Mailing Address - Phone:919-448-8262
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF ANESTHESIOLOGY N2198 UNC
Practice Address - Street 2:CB# 7010
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7010
Practice Address - Country:US
Practice Address - Phone:919-966-5136
Practice Address - Fax:984-974-4873
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC224595367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered