Provider Demographics
NPI:1841559184
Name:SHEPPARD, ANGELYN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELYN
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 EAGLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9121
Mailing Address - Country:US
Mailing Address - Phone:509-860-7869
Mailing Address - Fax:
Practice Address - Street 1:203 MISSION AVE STE 211
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1608
Practice Address - Country:US
Practice Address - Phone:509-860-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA18371600OtherWASHINGTON STATE LABOR AND INDUSTRY
WAMA00019846OtherWASHINGTON STATE DEPARTMENT OF HEALTH