Provider Demographics
NPI:1477622629
Name:SHEPPARD, HARLAN LAYNE (LMP)
Entity Type:Individual
Prefix:
First Name:HARLAN
Middle Name:LAYNE
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 686
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-0686
Mailing Address - Country:US
Mailing Address - Phone:509-860-1732
Mailing Address - Fax:
Practice Address - Street 1:833 FRONT ST
Practice Address - Street 2:SUITE 46
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1378
Practice Address - Country:US
Practice Address - Phone:509-860-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019966174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist