Healthcare Provider Details

I. General information

NPI: 1407221278
Provider Name (Legal Business Name): SHARLENE STOERING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 8TH ST NW
DILWORTH MN
56529-1003
US

IV. Provider business mailing address

102 8TH ST NW
DILWORTH MN
56529-1003
US

V. Phone/Fax

Practice location:
  • Phone: 218-790-1853
  • Fax:
Mailing address:
  • Phone: 218-790-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number0179510-1-AFC
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: