Provider Demographics
NPI:1023154846
Name:SHEEHAN, BROOKE ANN (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANN
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:ANN
Other - Last Name:BOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13177 SE JUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5233
Mailing Address - Country:US
Mailing Address - Phone:503-698-7661
Mailing Address - Fax:
Practice Address - Street 1:131 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4167
Practice Address - Country:US
Practice Address - Phone:503-253-6754
Practice Address - Fax:503-253-8020
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health