| Doctor Name: | MS. LARA SHIPLEY |
| NPI Number: | 1053727420 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 95000462 |
| Business Practice Address: | 1130 Fremont Blvd Suite 210b Seaside, CA - 939555700 |
| Business Phone Number: | 8317280222 |
| Business Fax Number: | 8317072777 |
| Mailing Address: | 195 Aviation Way, Suite 200 WATSONVILLE |
| State: | CA |
| Postal Code: | 950762053 |
| Phone Number: | 8317288250 |
| Fax Number: | 8317072777 |
| NPI Enumeration Date: | 07/07/2014 |
| NPI Last Update Date: | 03/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 95000462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |