| Ole Verni Shepherd, PA | |
|
710 S Kenwood Ave, Moose Lake, MN 55767-9405 | |
| (218) 485-4481 | |
| Not Available |
| Full Name | Ole Verni Shepherd |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 710 S Kenwood Ave, Moose Lake, Minnesota |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659318228 | NPI | - | NPPES |
| 292820500 | Medicaid | MN | |
| 41966500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 1517-023 (Wisconsin) | Secondary |
| 363A00000X | Physician Assistant | 8988 (Minnesota) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Ole Verni Shepherd, PA Rr 2 Box 196, St James, MN 56081-9653 Ph: (507) 327-7698 | Ole Verni Shepherd, PA 710 S Kenwood Ave, Moose Lake, MN 55767-9405 Ph: (218) 485-4481 |
Mr. Nathan Wayne Gilbertson, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 4570 County Highway 61, Moose Lake, MN 55767 Phone: 218-485-4491 |