Provider Demographics
NPI:1982750386
Name:SHEPHERD, ELIZABETH DALE (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DALE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:DALE
Other - Middle Name:
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5303 VAUGHN ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1120
Mailing Address - Country:US
Mailing Address - Phone:334-386-0343
Mailing Address - Fax:334-386-0382
Practice Address - Street 1:101 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7344
Practice Address - Country:US
Practice Address - Phone:334-335-3374
Practice Address - Fax:334-335-1119
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL023063367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered