Provider Demographics
NPI:1659610087
Name:SHEA, JUDY MARIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:MARIA
Last Name:SHEA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JUDY
Other - Middle Name:MARIA
Other - Last Name:KASPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1527 W LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5132
Mailing Address - Country:US
Mailing Address - Phone:414-405-9113
Mailing Address - Fax:
Practice Address - Street 1:1527 W LAWN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5132
Practice Address - Country:US
Practice Address - Phone:414-405-9113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101696-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse