Provider Demographics
NPI:1033555867
Name:KLEMMETSEN, SHIELA (MD)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:
Last Name:KLEMMETSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIELA
Other - Middle Name:
Other - Last Name:STEGORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10700
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-5517
Mailing Address - Country:US
Mailing Address - Phone:970-245-1220
Mailing Address - Fax:970-245-9148
Practice Address - Street 1:ESSENTIA HEALTH ST. JOSEPH'S-BAXTER CLINIC
Practice Address - Street 2:13060 ISLE DRIVE
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-828-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71720103Medicaid
CO71720103Medicaid