Provider Demographics
NPI:1619155462
Name:TOME, SHELLY REE
Entity Type:Individual
Prefix:MISS
First Name:SHELLY
Middle Name:REE
Last Name:TOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:REE
Other - Last Name:GILBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 BARSTAD RD N
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56229
Mailing Address - Country:US
Mailing Address - Phone:507-992-0299
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0620613164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse