MEDICARE: WANDA L SHEPPARD FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN000702	NV

General Provider Information

NPI Number	:	1518053917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANDA L SHEPPARD FNP

Provider Business Mailing Address
First Line	:	6893 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1640
Country	:	US
Telephone Number	:	702-338-2954
Fax Number	:	510-842-3543

Provider Business Practice Location Address
First Line	:	6893 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1640
Country	:	US
Telephone Number	:	702-338-2954
Fax Number	:	510-842-3543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	11/27/2015

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