Provider Demographics
NPI:1023314085
Name:LEWIS SHEPARD, PAULENSIA M (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAULENSIA
Middle Name:M
Last Name:LEWIS SHEPARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:PAULNESIA
Other - Middle Name:M
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8400 E YALE AVE
Mailing Address - Street 2:APT#3-106
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3857
Mailing Address - Country:US
Mailing Address - Phone:303-525-4567
Mailing Address - Fax:
Practice Address - Street 1:8400 E YALE AVE
Practice Address - Street 2:APT#3-106
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3857
Practice Address - Country:US
Practice Address - Phone:303-525-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46406164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse