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General NPI Number Information
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NPI Number | 1497156913
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Entity Type | Individual
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Provider Name | JORDAN SHEPLER
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Gender | Male
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 2033 W MOORESTOWN RD
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City | LAKE CITY
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State | MI
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Zip | 49651-9343
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Country | US
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Telephone | 231-229-4416
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Fax |
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Provider Business Mailing Address
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Address Line | 2033 W MOORESTOWN RD
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City | LAKE CITY
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State | MI
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Zip | 49651-9343
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Country | US
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Telephone | 231-229-4416
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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 | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | AF5703122005
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License Number State | MI
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