Healthcare Provider Details

I. General information

NPI: 1962998096
Provider Name (Legal Business Name): SHELBY LYNN ERNEST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2018
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5049 33RD AVE S
FARGO ND
58104-7080
US

IV. Provider business mailing address

5049 33RD AVE S
FARGO ND
58104-7080
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-1001
  • Fax: 701-639-4550
Mailing address:
  • Phone: 701-356-1001
  • Fax: 701-639-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR31203
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: