Healthcare Provider Details

I. General information

NPI: 1003800517
Provider Name (Legal Business Name): SHERYL MARIE BARTHOLOW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERYL MARIE REESE MSN

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 HENNEPIN AVE N
GLENCOE MN
55336
US

IV. Provider business mailing address

1805 HENNEPIN AVE N
GLENCOE MN
55336
US

V. Phone/Fax

Practice location:
  • Phone: 320-864-3121
  • Fax: 320-864-7887
Mailing address:
  • Phone: 320-864-3121
  • Fax: 320-864-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1056341
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR105634-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: