Healthcare Provider Details

I. General information

NPI: 1760530414
Provider Name (Legal Business Name): DONNA J SHEELY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 E PORTOBELLO AVE
MESA AZ
85212-1690
US

IV. Provider business mailing address

140 S GILBERT RD
GILBERT AZ
85296-1016
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-1404
  • Fax: 480-507-1666
Mailing address:
  • Phone: 480-507-1404
  • Fax: 480-507-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN126010
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: