Provider Demographics
NPI:1851848998
Name:SKEIM, SHANE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:SKEIM
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W GOOD SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1412
Mailing Address - Country:US
Mailing Address - Phone:218-745-4211
Mailing Address - Fax:218-745-3254
Practice Address - Street 1:300 W GOOD SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MN
Practice Address - Zip Code:56762-1412
Practice Address - Country:US
Practice Address - Phone:218-745-4211
Practice Address - Fax:218-745-3254
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily