1528218625 NPI number — MS. MARTHA G SHELVER NP

Table of content: MS. MARTHA G SHELVER NP (NPI 1528218625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528218625 NPI number — MS. MARTHA G SHELVER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHELVER
Provider First Name:
MARTHA
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMSON
Provider Other First Name:
MARTHA
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528218625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINOT
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58702-5010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-857-3655
Provider Business Mailing Address Fax Number:
701-857-3656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 3RD AVE. S.W.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-3380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-857-5650
Provider Business Practice Location Address Fax Number:
701-857-5031
Provider Enumeration Date:
09/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  NP-1040A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: R41244 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)