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NPI Code Detail

MEDICARE: AMBER RENAE SHEA RN, PMHNP

MEDICARE: AMBER RENAE SHEA RN, PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse25078AK
2363LP0808XPsychiatric/Mental Health Nurse Practitioner1313AK

General Provider Information

NPI Number : 1043559362
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBER RENAE SHEA RN, PMHNP
Provider Business Mailing Address
First Line : 5805 E COLUMBUS WAY
Second Line :
City : WASILLA
State : AK
Zip : 99654-7831
Country : US
Telephone Number : 907-376-7300
Fax Number : 888-977-2041
Provider Business Practice Location Address
First Line : 5805 E COLUMBUS WAY
Second Line :
City : WASILLA
State : AK
Zip : 99654-7831
Country : US
Telephone Number : 907-376-7300
Fax Number : 888-977-2041
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2013
Last Update Date : 02/08/2017

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