MEDICARE: SHEA M HERMES NNP

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
1	363L00000X	Nurse Practitioner	R1183311	MN
2	363LN0000X	Neonatal Nurse Practitioner	RN 079301	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588621304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEA M HERMES NNP

Provider Business Mailing Address
First Line	:	720 STEWART AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-4119
Country	:	US
Telephone Number	:	651-225-8350
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 STEWART AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-4119
Country	:	US
Telephone Number	:	651-225-8350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	09/16/2024

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