| Doctor Name: | DIANE SHEPHERD |
| NPI Number: | 1659646958 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | REGISTERED NURSE |
| License Number: | R-158091-4 |
| Business Practice Address: | 115 Sixth St. Nw Suite E Cass Lake, MN - 566013061 |
| Business Phone Number: | 2183358315 |
| Business Fax Number: | 2183354578 |
| Mailing Address: | 115 6th St. Nw, Suite E CASS LAKE |
| State: | MN |
| Postal Code: | 566333061 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/20/2012 |
| NPI Last Update Date: | 03/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WM0102X |
| License Number: | R-158091-4 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Maternal Newborn |
| Taxonomy Definition: | |