MEDICARE: TERESA SHEPARD RN, CDCES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN33317	NV

General Provider Information

NPI Number	:	1417666355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA SHEPARD RN, CDCES

Provider Business Mailing Address
First Line	:	5705 SILVER BELLE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4944
Country	:	US
Telephone Number	:	702-336-2929
Fax Number	:

Provider Business Practice Location Address
First Line	:	5705 SILVER BELLE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4944
Country	:	US
Telephone Number	:	702-336-2929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	11/18/2022

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