Shawn Theberge, APRN, FNP-C, NR-P

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

CNP201467 Issued in ME

Practice address

200 W Summit Ave
Wales, WI 53183-9427

Phone

(207) 650-7540

NPI assigned

Aug 12, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1205447455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CANYON WAY",
            "city": "WINDHAM",
            "state": "ME",
            "postal_code": "040624895",
            "telephone_number": "207-650-7540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W SUMMIT AVE",
            "city": "WALES",
            "state": "WI",
            "postal_code": "531839427",
            "telephone_number": "207-650-7540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEBERGE",
        "first_name": "SHAWN",
        "name_prefix": "Mr.",
        "credential": "APRN, FNP-C, NR-P",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-12",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "ME",
            "license": "P8036707",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "ME",
            "license": "RN72498",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ME",
            "license": "CNP201467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Charles Sizer
• Roger Alan Smith Jr., PHARMD
• Donna L Steuer, R.N.
• Summer Suvaka, MS, CCC-SLP
• Carrie Ann Tang, RN
• Judy Christine Thomas, LCSW
• Kaitlin Tom
• Mackenzie Van Dyke
• Vicki Lynn Waedekin, P.A.
• Wales Family Dental

• All providers in Wales, WI
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.