Basic Information
| Provider Information | |||||||||
| NPI: | 1447354717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEEHAN | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 297 NORTH ST STE 221 | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026015133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088627777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 495 STATION AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH YARMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026641218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087784777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2006 | ||||||||
| LastUpdateDate: | 06/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 210124 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 692607 | 01 | MA | HARVARD PILGRIMS | OTHER | 3117341 | 05 | MA | MEDICAID | 074512 | 01 | MA | TUFTS HEALTH | OTHER |