Provider Demographics
NPI:1831205640
Name:O SHEA, MELINDA S (ARNP)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:S
Last Name:O SHEA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E RUSHOLME STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803
Mailing Address - Country:US
Mailing Address - Phone:563-359-6633
Mailing Address - Fax:563-344-1371
Practice Address - Street 1:1510 E RUSHOLME STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803
Practice Address - Country:US
Practice Address - Phone:563-359-6633
Practice Address - Fax:563-344-1371
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF091357363LW0102X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0421487Medicaid
IA0421487Medicaid
IA47756Medicare PIN