Provider Demographics
NPI:1396076428
Name:ZANDER, SHUREE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:SHUREE
Middle Name:NICOLE
Last Name:ZANDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 AGENCY MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9705
Mailing Address - Country:US
Mailing Address - Phone:406-353-3250
Mailing Address - Fax:
Practice Address - Street 1:656 AGENCY MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9455
Practice Address - Country:US
Practice Address - Phone:406-353-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT36304163W00000X
MTRN-36304163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT36304OtherLICENSE