Provider Demographics
NPI:1396186334
Name:SHEA, BETH JOLYNN
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:JOLYNN
Last Name:SHEA
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 1:2803 CEDAR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6031
Mailing Address - Country:US
Mailing Address - Phone:319-268-7232
Mailing Address - Fax:
Practice Address - Street 1:2803 CEDAR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6031
Practice Address - Country:US
Practice Address - Phone:319-268-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-06
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA600107010292378183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician