Provider Demographics
NPI:1194791160
Name:OKEEFE, MARY SHEILA MARQUARDT (WHNP)
Entity type:Individual
Prefix:
First Name:MARY SHEILA
Middle Name:MARQUARDT
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:OKEEFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:2220 RIVERSIDE AVE
Practice Address - Street 2:MAIL STOP 31700A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:612-371-1600
Practice Address - Fax:612-371-1732
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0758912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P11622Medicare UPIN