Provider Demographics
NPI:1578619854
Name:O'SHEA, RENEE L (FNP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:L
Last Name:O'SHEA
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 1:5450 WESTERN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7610
Mailing Address - Fax:303-415-7618
Practice Address - Street 1:4747 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1133
Practice Address - Country:US
Practice Address - Phone:303-415-7610
Practice Address - Fax:303-415-7618
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0162540363LF0000X
COAPN.0005171-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO27123537Medicaid
CO27123537Medicaid