Individual
NYCOLE SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 456-6571
Mailing address
4923 ALLEN PARK DR APT N-I1, ALLENDALE, MI 49401-8648
(231) 408-2339
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/05/2021
Last updated
10/05/2021
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