Provider Demographics
NPI:1528505336
Name:HIPP, SHAWNA
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:HIPP
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 1:11634 MATVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-9773
Mailing Address - Country:US
Mailing Address - Phone:614-554-0871
Mailing Address - Fax:
Practice Address - Street 1:285 E STATE ST STE 430
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4358
Practice Address - Country:US
Practice Address - Phone:614-566-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily