Individual
SHELTANA MICHELLE HIPPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2435 FOREST DR, COLUMBIA, SC 29204-2026
(803) 409-7170
(803) 409-7175
Mailing address
1655 BERNARDIN AVE STE 220, COLUMBIA, SC 29204-2044
(803) 409-7170
(803) 409-7175
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
21620
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21620
MEDICAL LICENSE
SC
Enumeration date
03/09/2018
Last updated
03/09/2018
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