JEREMIAH RYAN SHUCK (NPI# 1033739925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033739925 |
| Entity Type | Individual |
| Full Name | JEREMIAH RYAN SHUCK |
| Practice Address |
3251 Basswood Shores Ln Nw Miltona MN 56354-8303 |
| Practice Telephone | 3207604248 |
| Mailing Telephone | 3207604248 |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2020-04-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
3251 BASSWOOD SHORES LN NW |
| City | MILTONA |
| State | MN |
| Zip Code | 56354-8303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477117885 | Kelly Rae Martin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13881 Schuelke Beach Rd Nw, Miltona, MN 56354 | 2019-05-01 |
| 1811535347 | Shannon Marie Leininger | Nurse Practitioner | 199 Pine Ave, Miltona, MN 56354-4505 | 2019-12-16 |
| 1881237998 | Sharon M Bridges | Physical Therapist | 755 County Road 14 Ne, Miltona, MN 56354-8150 | 2019-10-21 |
| 1447632096 | Ltcarerx Consulting LLC | Pharmacy | 15430 Frances Ln Nw, Miltona, MN 56354-8320 | 2015-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811535347 | Shannon Marie Leininger | Nurse Practitioner | 199 Pine Ave, Miltona, MN 56354-4505 | 2019-12-16 |
| 1881237998 | Sharon M Bridges | Physical Therapist | 755 County Road 14 Ne, Miltona, MN 56354-8150 | 2019-10-21 |
| 1477117885 | Kelly Rae Martin | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 13881 Schuelke Beach Rd Nw, Miltona, MN 56354 | 2019-05-01 |
| 1447632096 | Ltcarerx Consulting LLC | Pharmacy | 15430 Frances Ln Nw, Miltona, MN 56354-8320 | 2015-06-19 |
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154921047 | Liesa Clare Erickson | Student in an Organized Health Care Education/Training Program | 100 Elizabeth St Apt 416, Duluth, MN 55803-2643 | 2020-10-29 |
| 1639779804 | Chelsie Meemken | Student in an Organized Health Care Education/Training Program | 505 Bluebird Ct, Sartell, MN 56377-1633 | 2020-10-27 |
| 1134729486 | Anna R Spiczka | Student in an Organized Health Care Education/Training Program | 10689 108th Ave N, Hanover, MN 55341-4124 | 2020-10-27 |
| 1558961003 | Maren Elizabeth Iverson | Student in an Organized Health Care Education/Training Program | 1 Veterans Dr # 160, Minneapolis, MN 55417-2309 | 2020-10-26 |
| 1275132003 | Faizo A Hersi | Student in an Organized Health Care Education/Training Program | 9700 International Dr Suite 300, Bloomington, MN 55425 | 2020-10-22 |
| 1467059048 | Ashli Willow Boehm | Student in an Organized Health Care Education/Training Program | 1920 Turning Leaf Ln Sw, Alexandria, MN 56308-4662 | 2020-10-06 |
| 1174130421 | Carolyne Copley | Student in an Organized Health Care Education/Training Program | 226 2nd St Sw, Rochester, MN 55905-0001 | 2020-09-29 |
| 1023624483 | Katherine Hailey Lake | Student in an Organized Health Care Education/Training Program | 16415 Temple Dr, Minnetonka, MN 55345-3431 | 2020-09-21 |
| 1235745027 | Andrew Ryan Mcnamara | Student in an Organized Health Care Education/Training Program | 1015 Lowry Ave Ne Apt 3, Minneapolis, MN 55418-3727 | 2020-09-17 |
| 1740895770 | Arielle Johnson | Student in an Organized Health Care Education/Training Program | 1162 Thomas Ave, Saint Paul, MN 55104-2538 | 2020-09-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.