Individual
MS. SHELLEY LUEPHANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8515 OOLTEWAH GEORGETOWN RD, OOLTEWAH, TN 37363-9581
(423) 580-4092
Mailing address
8515 OOLTEWAH GEORGETOWN RD, OOLTEWAH, TN 37363-9581
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811439979
—
CA
Enumeration date
11/07/2016
Last updated
01/08/2021
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