Provider Demographics
NPI:1407802341
Name:SHEPPARD, LAUREL B (FNP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:B
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HILLS BEACH RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9526
Mailing Address - Country:US
Mailing Address - Phone:207-602-2358
Mailing Address - Fax:207-602-5904
Practice Address - Street 1:11 HILLS BEACH RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9526
Practice Address - Country:US
Practice Address - Phone:207-602-2358
Practice Address - Fax:207-602-5904
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30343120Medicaid
ME251530099Medicaid
MENP4742Medicare PIN
ME251530099Medicaid
MEP00834715Medicare PIN