Healthcare Provider Details

I. General information

NPI: 1295767663
Provider Name (Legal Business Name): JANET LEE SHEPHERD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E MONROE ST
MEXICO MO
65265-2919
US

IV. Provider business mailing address

2104 DICKINSON CT
COLUMBIA MO
65202-3322
US

V. Phone/Fax

Practice location:
  • Phone: 573-582-5000
  • Fax: 573-582-3729
Mailing address:
  • Phone: 573-214-0088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number146023
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: