Provider Demographics
NPI:1487924395
Name:SHIPMAN, PORTIA LAJOY
Entity type:Individual
Prefix:MS
First Name:PORTIA
Middle Name:LAJOY
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6444
Mailing Address - Country:US
Mailing Address - Phone:336-510-9393
Mailing Address - Fax:336-510-1499
Practice Address - Street 1:2200 E MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6444
Practice Address - Country:US
Practice Address - Phone:336-510-9393
Practice Address - Fax:336-510-1499
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4509376K00000X, 3747P1801X, 372600000X, 372500000X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC120005Medicaid
NC3419214Medicaid
NC6602355Medicaid