Provider Demographics
NPI:1508118514
Name:SHEPHARD-WIERBICKI, MARIE A (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:A
Last Name:SHEPHARD-WIERBICKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:A
Other - Last Name:SHEPHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2663
Mailing Address - Country:US
Mailing Address - Phone:716-876-3902
Mailing Address - Fax:
Practice Address - Street 1:205 YORKSHIRE RD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8350
Practice Address - Country:US
Practice Address - Phone:716-876-3902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY603653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse