Provider Demographics
NPI:1477672723
Name:SHEPHERD, CHRISTOPHER N (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:N
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:N
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4TH AND INNER LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-380-3199
Mailing Address - Fax:
Practice Address - Street 1:4TH AND INNER LOOP
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193444164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse