Provider Demographics
NPI:1568659241
Name:SHEPHERD, LOLITHA I (RN)
Entity Type:Individual
Prefix:
First Name:LOLITHA
Middle Name:I
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 BUCHTEL ST
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2003
Mailing Address - Country:US
Mailing Address - Phone:216-406-0470
Mailing Address - Fax:
Practice Address - Street 1:1925 BUCHTEL ST
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2003
Practice Address - Country:US
Practice Address - Phone:216-406-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH356342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse