Provider Demographics
NPI:1629629993
Name:EPPS, SHEENA (LPN)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:
Last Name:EPPS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:
Other - Last Name:CRESWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:637 JOHN B CARTER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7154
Mailing Address - Country:US
Mailing Address - Phone:904-674-4168
Mailing Address - Fax:
Practice Address - Street 1:637 JOHN B CARTER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-7154
Practice Address - Country:US
Practice Address - Phone:904-674-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse