Provider Demographics
NPI:1639467871
Name:SHEA, JONATHON J (RN)
Entity Type:Individual
Prefix:
First Name:JONATHON
Middle Name:J
Last Name:SHEA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2817
Mailing Address - Country:US
Mailing Address - Phone:715-219-2070
Mailing Address - Fax:
Practice Address - Street 1:4901 TULIP CT
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-7605
Practice Address - Country:US
Practice Address - Phone:715-574-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17622830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse