Healthcare Provider Details

I. General information

NPI: 1356258628
Provider Name (Legal Business Name): CHRISTINE J SHEPHERD CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 STATE ST STE 104A
BISMARCK ND
58503-0689
US

IV. Provider business mailing address

4007 STATE ST STE 104A
BISMARCK ND
58503-0689
US

V. Phone/Fax

Practice location:
  • Phone: 561-800-6877
  • Fax:
Mailing address:
  • Phone: 701-979-4487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberSHE-66-8800
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: