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General NPI Number Information
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NPI Number | 1215085444
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Entity Type | Individual
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Provider Name | THERESA MARY SHEPHARD RN
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 STODDARD RD
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City | RICHMOND
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State | MI
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Zip | 48062-2505
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Country | US
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Telephone | 810-392-2167
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Fax |
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Provider Business Mailing Address
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Address Line | 8122 BRICKER RD
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City | GREENWOOD
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State | MI
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Zip | 48006-1301
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Country | US
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Telephone | 810-387-9712
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 4704160329
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License Number State | MI
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