Healthcare Provider Details

I. General information

NPI: 1497497333
Provider Name (Legal Business Name): MISHELL J SHIPMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISHELL J QUIRIDUMBAY VERDUGO MD

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 28TH AVE S
MOORHEAD MN
56560-7926
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3200
  • Fax: 701-324-3239
Mailing address:
  • Phone: 605-328-6588
  • Fax: 605-328-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number81950
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24124
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: