Provider Demographics
NPI:1326315706
Name:SHEEHAN, ANDREA THEA
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:THEA
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DE PAUL TREATMENT CENTERS
Mailing Address - Street 2:P.O. BOX 3007
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208
Mailing Address - Country:US
Mailing Address - Phone:503-535-1151
Mailing Address - Fax:
Practice Address - Street 1:1312 SW WASHINGTON ST
Practice Address - Street 2:DE PAUL TREATMENT CENTERS
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-535-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200241871RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse