Provider Demographics
NPI:1831310929
Name:MYHRE, KIM SHIRLEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:SHIRLEY
Last Name:MYHRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:SHIRLEY
Other - Last Name:GILLINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3444 170TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264-1886
Mailing Address - Country:US
Mailing Address - Phone:507-872-5481
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:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1244674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse