Provider Demographics
NPI:1043559362
Name:SHEA, AMBER RENAE (RN, PMHNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:RENAE
Last Name:SHEA
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 E COLUMBUS WAY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7831
Mailing Address - Country:US
Mailing Address - Phone:907-376-7300
Mailing Address - Fax:888-977-2041
Practice Address - Street 1:5805 E COLUMBUS WAY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7831
Practice Address - Country:US
Practice Address - Phone:907-376-7300
Practice Address - Fax:888-977-2041
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK25078163W00000X
AK1313363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse