Provider Demographics
NPI:1588961650
Name:SHEAN, ELLEN SUSAN (RN,NP-C)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:SUSAN
Last Name:SHEAN
Suffix:
Gender:F
Credentials:RN,NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-2214
Mailing Address - Country:US
Mailing Address - Phone:619-595-5050
Mailing Address - Fax:619-595-5915
Practice Address - Street 1:2025 HARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2214
Practice Address - Country:US
Practice Address - Phone:619-595-5050
Practice Address - Fax:619-595-5915
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR299933363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health