Healthcare Provider Details

I. General information

NPI: 1346154275
Provider Name (Legal Business Name): JAYME SHEA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E WASHINGTON ST STE 1A
APPLETON WI
54911-5447
US

IV. Provider business mailing address

610 N BADGER AVE
APPLETON WI
54914-3405
US

V. Phone/Fax

Practice location:
  • Phone: 920-460-7209
  • Fax:
Mailing address:
  • Phone: 920-460-7209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number13574530
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: