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General NPI Number Information
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NPI Number | 1023784808
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Entity Type | Individual
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Provider Name | JULIE ANNA SHEPARD LPN
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Gender | Female
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 604 LAFAYETTE ST
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City | WATERLOO
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State | IA
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Zip | 50703-4708
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Country | US
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Telephone | 833-370-0719
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Fax |
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Provider Business Mailing Address
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Address Line | 136 JOHNS DR
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City | ELK RUN HEIGHTS
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State | IA
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Zip | 50707-1438
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Country | US
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Telephone | 319-290-6516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | P42497
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License Number State | IA
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