Provider Demographics
NPI:1801495361
Name:GBIEOR, SHYANN IRENE
Entity type:Individual
Prefix:
First Name:SHYANN
Middle Name:IRENE
Last Name:GBIEOR
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 1:2453 27TH AVE S APT 929
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-6453
Mailing Address - Country:US
Mailing Address - Phone:218-779-8382
Mailing Address - Fax:
Practice Address - Street 1:2453 27TH AVE S APT 929
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6453
Practice Address - Country:US
Practice Address - Phone:218-779-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant