Provider Demographics
NPI:1639177983
Name:SHEEHAN, ANN PATRICE (DNP, CPNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:PATRICE
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1282
Mailing Address - Country:US
Mailing Address - Phone:269-327-5700
Mailing Address - Fax:269-327-1564
Practice Address - Street 1:670 MALL DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-2878
Practice Address - Country:US
Practice Address - Phone:269-327-1900
Practice Address - Fax:269-327-1564
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704160324363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
S97399Medicare UPIN
MI3050848Medicaid