Healthcare Provider Details

I. General information

NPI: 1003999855
Provider Name (Legal Business Name): JACQUELINE ANN SHEEHAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SW 100TH RD
WARRENSBURG MO
64093-8140
US

IV. Provider business mailing address

70 SW 100TH RD
WARRENSBURG MO
64093-8140
US

V. Phone/Fax

Practice location:
  • Phone: 660-422-2646
  • Fax:
Mailing address:
  • Phone: 660-422-2646
  • Fax: 520-533-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2009018972
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number91104
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: