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General NPI Number Information
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NPI Number | 1801317417
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Entity Type | Individual
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Provider Name | SHELBY LAINE KNOX PA
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Gender | Female
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 810 N WELO ST
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City | TIOGA
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State | ND
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Zip | 58852-7157
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Country | US
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Telephone | 701-664-3305
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Fax | 701-664-2240
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Provider Business Mailing Address
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Address Line | 810 N WELO ST
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City | TIOGA
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State | ND
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Zip | 58852-7157
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Country | US
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Telephone | 701-664-3305
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Fax | 701-664-2240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0886
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License Number State | ND
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