Provider Demographics
NPI:1578158325
Name:UNDERWOOD, SHEILA RENAE (FNP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:RENAE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BROWN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63873-9317
Mailing Address - Country:US
Mailing Address - Phone:157-437-9069
Mailing Address - Fax:
Practice Address - Street 1:2865 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2803
Practice Address - Country:US
Practice Address - Phone:573-776-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020034599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily