MEDICARE: JORDAN SHEPLER

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	253J00000X	Foster Care Agency	AF5703122005	MI

General Provider Information

NPI Number	:	1497156913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SHEPLER

Provider Business Mailing Address
First Line	:	2033 W MOORESTOWN RD
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-9343
Country	:	US
Telephone Number	:	231-229-4416
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 W MOORESTOWN RD
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-9343
Country	:	US
Telephone Number	:	231-229-4416
Fax Number	:

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

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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Directions to “ JORDAN SHEPLER ” Practice Location

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