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Individual

DIANE SHEPHERD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
REGISTERED NURSE

Contact information

Practice address
115 SIXTH ST. NW, SUITE E, CASS LAKE, MN 56601-3061
(218) 335-8315
(218) 335-4578
Mailing address
115 6TH ST. NW, SUITE E, CASS LAKE, MN 56633-3061

Taxonomy

Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R-158091-4
MN
163WM0102X
Maternal Newborn Registered Nurse
R-158091-4
MN
163WP0808X
Psychiatric/Mental Health Registered Nurse
R-158091-4
MN

Other

Enumeration date
03/20/2012
Last updated
03/20/2012
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