1215228721 NPI number — SHELLEY LARICE STROJNY FPMHNP-BC

Table of content: SHELLEY LARICE STROJNY FPMHNP-BC (NPI 1215228721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215228721 NPI number — SHELLEY LARICE STROJNY FPMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROJNY
Provider First Name:
SHELLEY
Provider Middle Name:
LARICE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FPMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215228721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2044 NORTHSTAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENS POINT
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54482-9316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-341-8162
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E VETERANS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOMAH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54660-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-842-2834
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2011

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: 363LP0808X , with the licence number:  4347-033 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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