Provider Demographics
NPI:1427855428
Name:SHEPARD, MACOLE LASHAY
Entity type:Individual
Prefix:
First Name:MACOLE
Middle Name:LASHAY
Last Name:SHEPARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 FORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1733
Mailing Address - Country:US
Mailing Address - Phone:402-739-0479
Mailing Address - Fax:
Practice Address - Street 1:2503 FORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1733
Practice Address - Country:US
Practice Address - Phone:402-739-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide