Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | OR |
NPI | 1023154846 |
---|---|
Provider Name | Mrs. Brooke Ann Sheehan |
First Address | Clackamas, OR 97015-5233 |
Second Address | Portland, OR 97220-4167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |