Provider Demographics
NPI:1033854427
Name:SHEAHEN, KANDISE L (RN)
Entity Type:Individual
Prefix:
First Name:KANDISE
Middle Name:L
Last Name:SHEAHEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KANDISE
Other - Middle Name:L
Other - Last Name:SPORER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:165801 STATE HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5718
Mailing Address - Country:US
Mailing Address - Phone:715-432-1986
Mailing Address - Fax:
Practice Address - Street 1:165801 STATE HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5718
Practice Address - Country:US
Practice Address - Phone:715-432-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163907-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health