Provider Demographics
NPI:1205861622
Name:MYHRE, SHAWN MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:MYHRE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 N POTSDAM AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-7017
Mailing Address - Country:US
Mailing Address - Phone:605-338-2066
Mailing Address - Fax:605-371-3754
Practice Address - Street 1:3415 N POTSDAM AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-7017
Practice Address - Country:US
Practice Address - Phone:605-338-2066
Practice Address - Fax:605-371-3754
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000458363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6826292Medicaid
SD6826292Medicaid