=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033496385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN KELSEY SHEHAN RN, MSN, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2011
-----------------------------------------------------
Last Update Date | 07/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 NEW WAVERLY PL STE 205 SUITE 205
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27518-7404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-468-6820
-----------------------------------------------------
Fax | 919-468-6484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2633 SIERRA DR
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27603-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-880-1327
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 244861
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------