Provider Demographics
NPI:1962059311
Name:SHEA, JOSEPHINE L (FNP)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:L
Last Name:SHEA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:C
Other - Last Name:LANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:63 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5010
Mailing Address - Country:US
Mailing Address - Phone:978-270-5636
Mailing Address - Fax:
Practice Address - Street 1:63 FRONT ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5010
Practice Address - Country:US
Practice Address - Phone:978-270-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF07190239207Q00000X
MARN2295025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine