Healthcare Provider Details

I. General information

NPI: 1750109096
Provider Name (Legal Business Name): MARGARET E SHUPE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET E JARRETTE

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

692 E BROADWAY ST
MONON IN
47959-8191
US

IV. Provider business mailing address

1202 N SADDLEBROOK CT
MONTICELLO IN
47960-2483
US

V. Phone/Fax

Practice location:
  • Phone: 800-321-5043
  • Fax: 877-727-7640
Mailing address:
  • Phone: 574-270-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015967A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: