Healthcare Provider Details

I. General information

NPI: 1184830580
Provider Name (Legal Business Name): SHEILA LEE SHIPMAN IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMCB SEVEN UNIT 60252
GULFPORT MS
34099-5061
US

IV. Provider business mailing address

3513 BEASLEY RD APT 5F
GAUTIER MS
39553-5032
US

V. Phone/Fax

Practice location:
  • Phone: 228-871-2810
  • Fax: 228-871-2135
Mailing address:
  • Phone: 228-383-5888
  • Fax: 228-871-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: