Provider Demographics
NPI:1215984919
Name:SHEPHERD, MARENE MARCELLA (CRNA)
Entity type:Individual
Prefix:
First Name:MARENE
Middle Name:MARCELLA
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARENE
Other - Middle Name:M
Other - Last Name:KIEFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-0319
Mailing Address - Country:US
Mailing Address - Phone:636-938-6868
Mailing Address - Fax:636-549-2372
Practice Address - Street 1:7145 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4322
Practice Address - Country:US
Practice Address - Phone:225-765-3111
Practice Address - Fax:225-765-3114
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04690367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered