Provider Demographics
NPI:1508675596
Name:SHEPARD, MARESSA MICHELE
Entity type:Individual
Prefix:
First Name:MARESSA
Middle Name:MICHELE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5398
Mailing Address - Country:US
Mailing Address - Phone:509-948-1312
Mailing Address - Fax:
Practice Address - Street 1:4306 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5398
Practice Address - Country:US
Practice Address - Phone:509-948-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABD61596074374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula