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General NPI Number Information
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NPI Number | 1720356306
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Entity Type | Individual
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Provider Name | MARY ELIZABETH SHEPHERD CNA
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Gender | Female
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 01/28/2012
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Provider Practice Location Address
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Address Line | 765 APRILE AVE S
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City | LEHIGH ACRES
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State | FL
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Zip | 33974-2520
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Country | US
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Telephone | 239-887-1559
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Fax | 239-303-7345
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Provider Business Mailing Address
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Address Line | 765 APRILE AVE S
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City | LEHIGH ACRES
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State | FL
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Zip | 33974-2520
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Country | US
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Telephone | 239-887-1559
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Fax | 239-303-7345
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA 217 251
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License Number State | FL
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