Healthcare Provider Details

I. General information

NPI: 1275273153
Provider Name (Legal Business Name): ABIGAIL E SHIPP DIP CBE(CBI), CBD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E OAK ST
RED OAK IA
51566-1640
US

IV. Provider business mailing address

511 E OAK ST
RED OAK IA
51566-1640
US

V. Phone/Fax

Practice location:
  • Phone: 402-669-7345
  • Fax:
Mailing address:
  • Phone: 402-669-7345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: