Provider Demographics
NPI:1770306284
Name:FLOM, SHAWNA CHRISTINE
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:CHRISTINE
Last Name:FLOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CAMBRIDGE CV
Mailing Address - Street 2:
Mailing Address - City:SURREY
Mailing Address - State:ND
Mailing Address - Zip Code:58785-5008
Mailing Address - Country:US
Mailing Address - Phone:701-509-3093
Mailing Address - Fax:
Practice Address - Street 1:2004 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3435
Practice Address - Country:US
Practice Address - Phone:701-721-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker