Provider Demographics
NPI:1891869061
Name:SZYMONSKI, SHIELA R (CNP)
Entity Type:Individual
Prefix:MRS
First Name:SHIELA
Middle Name:R
Last Name:SZYMONSKI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:SHIELA
Other - Middle Name:
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:350 PINE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1669
Mailing Address - Country:US
Mailing Address - Phone:605-721-8939
Mailing Address - Fax:
Practice Address - Street 1:350 PINE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1669
Practice Address - Country:US
Practice Address - Phone:605-721-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR024930363LF0000X
SDCP000390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6825280Medicaid
SD4993415OtherWELLMARK
SD6825282Medicaid
SDP00368649OtherRR MEDICARE
SD9240146OtherDAKOTACARE
Q08328Medicare UPIN
SDS41657Medicare ID - Type Unspecified
SDS101353Medicare PIN