Provider Demographics
NPI:1538150461
Name:HENNESSY, MAUREEN SHEA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:SHEA
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4643
Mailing Address - Country:US
Mailing Address - Phone:781-848-2448
Mailing Address - Fax:
Practice Address - Street 1:41 HIGHLAND AVE.
Practice Address - Street 2:WINCHESTER HOSPITAL
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1496
Practice Address - Country:US
Practice Address - Phone:781-729-9000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128565367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA 0442Medicare ID - Type UnspecifiedNURSE ANESTHETIST