Healthcare Provider Details

I. General information

NPI: 1164357034
Provider Name (Legal Business Name): SHEA KEENAN APRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 EXCELSIOR BLVD
ST LOUIS PARK MN
55426-4702
US

IV. Provider business mailing address

8904 STANLEN RD
ST LOUIS PARK MN
55426-2348
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-6016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3405
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2473450
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: