Provider Demographics
NPI:1295979862
Name:SHEPARD, MELISSA A (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S HURON RD
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-9449
Mailing Address - Country:US
Mailing Address - Phone:989-992-1519
Mailing Address - Fax:
Practice Address - Street 1:208 WEBER ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9487
Practice Address - Country:US
Practice Address - Phone:989-266-3167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704177203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse