Provider Demographics
NPI:1922557313
Name:SHEPARD, DIANE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9436
Mailing Address - Country:US
Mailing Address - Phone:303-902-6740
Mailing Address - Fax:
Practice Address - Street 1:817 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9436
Practice Address - Country:US
Practice Address - Phone:303-902-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education