Individual
OLE VERNI SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
710 S KENWOOD AVE, MOOSE LAKE, MN 55767-9405
(218) 485-4481
Mailing address
RR 2 BOX 196, ST JAMES, MN 56081-9653
(507) 327-7698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1517-023
WI
363A00000X
Physician Assistant
Primary
8988
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292820500
—
MN
05
—
41966500
—
WI
Enumeration date
06/01/2006
Last updated
05/25/2012
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