Provider Demographics
NPI:1518053917
Name:SHEPPARD, WANDA L (FNP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:L
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:L
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:6893 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1640
Mailing Address - Country:US
Mailing Address - Phone:702-338-2954
Mailing Address - Fax:510-842-3543
Practice Address - Street 1:6893 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1640
Practice Address - Country:US
Practice Address - Phone:702-338-2954
Practice Address - Fax:510-842-3543
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV105810Medicare UPIN