Provider Demographics
NPI:1780195016
Name:SHEPHERD, DEBORAH ANN (RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:817 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3602
Mailing Address - Country:US
Mailing Address - Phone:610-931-7053
Mailing Address - Fax:
Practice Address - Street 1:817 GREEN LN
Practice Address - Street 2:
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-3602
Practice Address - Country:US
Practice Address - Phone:610-931-7053
Practice Address - Fax:610-931-7053
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN304440L163WH0200X, 163W00000X, 251J00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No251J00000XAgenciesNursing Care