Provider Demographics
NPI:1124016928
Name:O'SHEA, NOREEN ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:ELLEN
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2355
Mailing Address - Country:US
Mailing Address - Phone:515-248-1490
Mailing Address - Fax:515-248-1440
Practice Address - Street 1:2353 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1109
Practice Address - Country:US
Practice Address - Phone:515-248-1400
Practice Address - Fax:515-248-1414
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2215207P00000X
SD4034207Q00000X
IA02215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDC63054Medicare UPIN
SD7740Medicare PIN
IAI0524001Medicare PIN
SD7688Medicare PIN