Provider Demographics
NPI:1669250684
Name:SHEPHERD, VENUS MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:MARIE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VENUS
Other - Middle Name:MARIE
Other - Last Name:KONDRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2265 MARIETTA BLVD NW APT 1416
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2035
Mailing Address - Country:US
Mailing Address - Phone:414-235-1659
Mailing Address - Fax:
Practice Address - Street 1:2265 MARIETTA BLVD NW APT 1416
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2035
Practice Address - Country:US
Practice Address - Phone:414-235-1659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse