Individual
LISA MARIE SHEPARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
21245 110TH AVE SE, KENT, WA 98031-2145
(253) 886-8578
Mailing address
21245 110TH AVE SE, KENT, WA 98031-2145
(253) 886-8578
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60204242
WA
Other
Enumeration date
03/14/2012
Last updated
03/14/2012
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