Healthcare Provider Details

I. General information

NPI: 1508675596
Provider Name (Legal Business Name): MARESSA MICHELE SHEPARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4306 STAFFORD DR
PASCO WA
99301-5398
US

IV. Provider business mailing address

4306 STAFFORD DR
PASCO WA
99301-5398
US

V. Phone/Fax

Practice location:
  • Phone: 509-948-1312
  • Fax:
Mailing address:
  • Phone: 509-948-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBD61596074
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM25080824
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: