Provider Demographics
NPI:1184116048
Name:SHEEHAN, CAROLINE (NNP-BC, MSN, RN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:NNP-BC, MSN, RN
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:MAINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:601 CHILDRENS LN FL 4
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1971
Mailing Address - Country:US
Mailing Address - Phone:757-668-7452
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN FL 4
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1971
Practice Address - Country:US
Practice Address - Phone:757-668-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA241761102080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA17144887OtherAUTHORIZATION TO PRESCRIBE LICENSE
104417186OtherNEONATAL NURSE PRACTITIONER BOARD CERTIFICATION - NATIONAL CERTIFICATION CORP.
VA1245220OtherREGISTERED NURSE LICENSE
VA24176110OtherVIRGINIA NURSE PRACTITIONER LICENSE