Provider Demographics
NPI:1205023926
Name:DOBRZELECKI, SHAWNA L (NP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:L
Last Name:DOBRZELECKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 S GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0848
Mailing Address - Country:US
Mailing Address - Phone:937-269-1798
Mailing Address - Fax:
Practice Address - Street 1:811 E INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1100
Practice Address - Country:US
Practice Address - Phone:701-221-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH298435363LF0000X
NDR33229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000032022OtherBCBS
OHNP24962Medicare PIN