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Individual

HEATHER M SHOUP

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
2350 MIAMI VALLEY DR STE 500, DAYTON, OH 45459-4780
(937) 293-1622
(937) 245-6308
Mailing address
6680 POE AVE STE 200, DAYTON, OH 45414-2855
(937) 280-8400
(937) 280-8373

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN317714
OH
363L00000X
Nurse Practitioner
COA16815NP
OH
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN.CNP.16815
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0113882
OH
Enumeration date
10/31/2014
Last updated
01/07/2022
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