Provider Demographics
NPI:1255404810
Name:SHAPARD, ELIZABETH D (RN MSN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:SHAPARD
Suffix:
Gender:F
Credentials:RN MSN PMHNP-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2810 E DEL MAR BLVD STE 14
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-6709
Mailing Address - Country:US
Mailing Address - Phone:626-999-4242
Mailing Address - Fax:
Practice Address - Street 1:2810 E DEL MAR BLVD STE 14
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-6709
Practice Address - Country:US
Practice Address - Phone:626-999-4242
Practice Address - Fax:626-604-4199
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20782363LW0102X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health