Provider Demographics
NPI:1750168217
Name:STORTZ, SHELLEY ANNE (NRP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANNE
Last Name:STORTZ
Suffix:
Gender:F
Credentials:NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2813
Mailing Address - Country:US
Mailing Address - Phone:605-391-4863
Mailing Address - Fax:605-342-3692
Practice Address - Street 1:308 QUINCY ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2813
Practice Address - Country:US
Practice Address - Phone:605-391-4863
Practice Address - Fax:605-342-3692
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD19709146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic