Healthcare Provider Details

I. General information

NPI: 1962429829
Provider Name (Legal Business Name): SHIRLEY A ESSARY CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 BROADWAY
FARGO ND
58122-0001
US

IV. Provider business mailing address

737 BROADWAY
FARGO ND
58122-0001
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-5044
  • Fax: 701-234-3838
Mailing address:
  • Phone: 701-234-5044
  • Fax: 701-234-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberR16152
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: