Provider Demographics
NPI:1881611770
Name:BARTOW, SHELLEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:MARIE
Last Name:BARTOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:KENMARE
Mailing Address - State:ND
Mailing Address - Zip Code:58746-0755
Mailing Address - Country:US
Mailing Address - Phone:701-385-3020
Mailing Address - Fax:701-385-3033
Practice Address - Street 1:100 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746-7329
Practice Address - Country:US
Practice Address - Phone:701-385-3020
Practice Address - Fax:701-385-3033
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24396OtherNORTH DAKOTA BLUE SHIELD
NDN24396Medicare PIN
Q 15288Medicare UPIN