1538259825 NPI number — ERIKA C SHEA CRNP

Table of content: ERIKA C SHEA CRNP (NPI 1538259825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538259825 NPI number — ERIKA C SHEA CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEA
Provider First Name:
ERIKA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538259825
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 MARKET STREET
Provider Second Line Business Mailing Address:
LM 500 WEST TOWER
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19120-2100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-985-2595
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 W LEHIGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-765-2272
Provider Business Practice Location Address Fax Number:
215-426-5123
Provider Enumeration Date:
10/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  SP008206 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30066990 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 42448 . This is a "UNIVERSITY HEALTHPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1452893 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538259825 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2565975 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60020564 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010006972 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1025162600001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3K6507 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3546319 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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