Provider Demographics
NPI:1629811724
Name:SHEPHARD-OWENS, GLORIA MAYNOR
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:MAYNOR
Last Name:SHEPHARD-OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:MAYNOR
Other - Last Name:SHEPHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8204 IMPATIENTS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131
Mailing Address - Country:US
Mailing Address - Phone:702-243-6621
Mailing Address - Fax:
Practice Address - Street 1:8204 IMPATIENTS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131
Practice Address - Country:US
Practice Address - Phone:702-243-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider