Provider Demographics
NPI:1821334913
Name:SHCHUR, NELLI Y (CNP)
Entity Type:Individual
Prefix:
First Name:NELLI
Middle Name:Y
Last Name:SHCHUR
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 1:2400 S. MINNESOTA AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-3762
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1301 S. CLIFF AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1032
Practice Address - Country:US
Practice Address - Phone:605-322-8860
Practice Address - Fax:605-322-8868
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR036344363LF0000X
SDCP000780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6831203Medicaid
SDP01221128OtherRR MEDICARE
SDS107422Medicare PIN