Healthcare Provider Details

I. General information

NPI: 1124016928
Provider Name (Legal Business Name): NOREEN ELLEN O'SHEA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 SE 14TH ST
DES MOINES IA
50320-1109
US

IV. Provider business mailing address

1200 UNIVERSITY AVE STE 200
DES MOINES IA
50314-2355
US

V. Phone/Fax

Practice location:
  • Phone: 515-248-1400
  • Fax: 515-248-1414
Mailing address:
  • Phone: 515-248-1490
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2215
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4034
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02215
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: