Provider Demographics
NPI:1558788000
Name:SHEPHERD, VANESSA (LPN)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:1422 MILAN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1547
Mailing Address - Country:US
Mailing Address - Phone:330-836-1403
Mailing Address - Fax:
Practice Address - Street 1:1422 MILAN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1547
Practice Address - Country:US
Practice Address - Phone:330-836-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144504164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse