Healthcare Provider Details

I. General information

NPI: 1902739691
Provider Name (Legal Business Name): PAULA JEAN SHUPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CLEVER LN
LEXINGTON OH
44904-1269
US

IV. Provider business mailing address

5822 ANKNEYTOWN RD
BELLVILLE OH
44813-8952
US

V. Phone/Fax

Practice location:
  • Phone: 419-884-1111
  • Fax:
Mailing address:
  • Phone: 419-884-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number253634
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: