Provider Demographics
NPI:1013360700
Name:SHEPPARD, CRAIG (RN)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 INDUSTRIAL RD
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-1901
Mailing Address - Country:US
Mailing Address - Phone:973-839-2521
Mailing Address - Fax:973-686-2258
Practice Address - Street 1:7 INDUSTRIAL RD
Practice Address - Street 2:
Practice Address - City:PEQUANNOCK
Practice Address - State:NJ
Practice Address - Zip Code:07440-1901
Practice Address - Country:US
Practice Address - Phone:973-839-2521
Practice Address - Fax:973-686-2258
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16890300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse