Healthcare Provider Details

I. General information

NPI: 1770306284
Provider Name (Legal Business Name): SHAWNA CHRISTINE FLOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 2ND AVE SW
MINOT ND
58701-3435
US

IV. Provider business mailing address

11 CAMBRIDGE CV
SURREY ND
58785-5008
US

V. Phone/Fax

Practice location:
  • Phone: 701-721-6024
  • Fax:
Mailing address:
  • Phone: 701-509-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: