Healthcare Provider Details

I. General information

NPI: 1386926186
Provider Name (Legal Business Name): URIEL JOHN SHIMPANO FNP, CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 M 139
BENTON HARBOR MI
49022-5711
US

IV. Provider business mailing address

1485 M 139
BENTON HARBOR MI
49022-5711
US

V. Phone/Fax

Practice location:
  • Phone: 269-925-0585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704431732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: