MEDICARE: SHAWN MARIE MYHRE CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	CP000458	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205861622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MARIE MYHRE CNP

Provider Business Mailing Address
First Line	:	3415 N POTSDAM AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-7017
Country	:	US
Telephone Number	:	605-338-2066
Fax Number	:	605-371-3754

Provider Business Practice Location Address
First Line	:	3415 N POTSDAM AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-7017
Country	:	US
Telephone Number	:	605-338-2066
Fax Number	:	605-371-3754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/10/2011

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