Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD165345 | OR |
N | 2080P0207X | Pediatric Hematology-Oncologist | MD165345 | OR |
NPI | 1144529306 |
---|---|
Provider Name | Dr. Jennifer Eileen Shepard |
First Address | Oregon City, OR 97045-1581 |
Second Address | Oregon City, OR 97045-1581 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2011 |
Last Update Date | 23/06/2014 |