Provider Demographics
NPI:1083109615
Name:SHEPARD, SENECA F (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SENECA
Middle Name:F
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SENECA
Other - Middle Name:M
Other - Last Name:FAYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3821 CHARBONNETT CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4900
Mailing Address - Country:US
Mailing Address - Phone:614-962-0229
Mailing Address - Fax:
Practice Address - Street 1:3821 CHARBONNETT CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4900
Practice Address - Country:US
Practice Address - Phone:614-962-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150807164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse