Individual
GLENDA MCGOWEN SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2901 BRIDGEPORT WAY W, UNIVERSITY PLACE, WA 98466-4614
(253) 534-7000
(253) 534-7099
Mailing address
2901 BRIDGEPORT WAY W, UNIVERSITY PLACE, WA 98466-4614
(253) 534-7000
(253) 534-7099
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP60243389
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0289071
STATE L&I
WA
01
—
0289073
STATE L&I
WA
Enumeration date
12/14/2011
Last updated
03/09/2012
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