Provider Demographics
NPI:1457638363
Name:SHEPHERD, TAMMY LYNN (LPN-M-IV)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LPN-M-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 GUTHRIE RD
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:OH
Mailing Address - Zip Code:44878-8897
Mailing Address - Country:US
Mailing Address - Phone:419-896-3432
Mailing Address - Fax:
Practice Address - Street 1:7151 GUTHRIE RD
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:OH
Practice Address - Zip Code:44878-8897
Practice Address - Country:US
Practice Address - Phone:419-896-3432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN087202164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse