Provider Demographics
NPI:1841249968
Name:SHEPPARD-MADDEN, DENA SUE (MD)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:SUE
Last Name:SHEPPARD-MADDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:SUE
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-1381
Mailing Address - Country:US
Mailing Address - Phone:970-532-4910
Mailing Address - Fax:970-532-2850
Practice Address - Street 1:401 10TH ST
Practice Address - Street 2:
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-1381
Practice Address - Country:US
Practice Address - Phone:970-532-4910
Practice Address - Fax:970-532-2850
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
84132889806OtherPACIFICARE
84132889807OtherSECURE HORIZONS
CO01289693Medicaid
84132889801OtherROCKY MOUNTAIN HEALTH PLA
84132889806OtherSECURE HORIZONS
84132889807OtherPACIFICARE
84132889807OtherPACIFICARE
84132889806OtherPACIFICARE
84132889806OtherSECURE HORIZONS