Healthcare Provider Details

I. General information

NPI: 1033555867
Provider Name (Legal Business Name): SHIELA KLEMMETSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIELA STEGORA

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESSENTIA HEALTH ST. JOSEPH'S-BAXTER CLINIC 13060 ISLE DRIVE
BAXTER MN
56425
US

IV. Provider business mailing address

PO BOX 10700
GRAND JUNCTION CO
81502-5517
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-2880
  • Fax:
Mailing address:
  • Phone: 970-245-1220
  • Fax: 970-245-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0054133
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: