Provider Demographics
NPI:1376817635
Name:SHEEHAN, CARYN ALICE (APRN)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:ALICE
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03261-3705
Mailing Address - Country:US
Mailing Address - Phone:603-224-4093
Mailing Address - Fax:
Practice Address - Street 1:30 PILLSBURY ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3502
Practice Address - Country:US
Practice Address - Phone:603-224-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039513-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner