Provider Demographics
NPI:1720356306
Name:SHEPHERD, MARY ELIZABETH (CNA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 APRILE AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-2520
Mailing Address - Country:US
Mailing Address - Phone:239-887-1559
Mailing Address - Fax:239-303-7345
Practice Address - Street 1:765 APRILE AVE S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-2520
Practice Address - Country:US
Practice Address - Phone:239-887-1559
Practice Address - Fax:239-303-7345
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 217 251376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide