Provider Demographics
NPI:1427885748
Name:SHEA, LAUREN (APRN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 OLD COLONY AVE APT 432
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-7909
Mailing Address - Country:US
Mailing Address - Phone:860-992-3743
Mailing Address - Fax:
Practice Address - Street 1:50 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1711
Practice Address - Country:US
Practice Address - Phone:978-922-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2325516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner