DR. KELLY LYNN SHANLEY NORDSTROM (NPI# 1194930370) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194930370 |
| Entity Type | Individual |
| Full Name | DR. KELLY LYNN SHANLEY NORDSTROM |
| Credential | PHARMD |
| Practice Address |
2321 Stout Rd Menomonie WI 54751-7003 |
| Mailing Address |
3706 Tiffany Ln Eau Claire WI 54701-5635 |
| Practice Telephone | 7152337500 |
| Practice Fax Number | 7152337501 |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | 14450-040 | WI | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306371083 | Kelly Nordstrom | Licensed Vocational Nurse | 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4654 | 2017-05-01 |
| 1548363005 | Kelly Sue Nordstrom | Pharmacist | 325 E H St, Iron Mountain, MI 49801-4760 | 2006-09-07 |
| 1689642076 | Kelly M Nordstrom | Nurse Practitioner | 9 Hope Ave, Waltham, MA 02453-2741 | 2006-03-10 |
| Street Address |
2321 STOUT RD |
| City | MENOMONIE |
| State | WI |
| Zip Code | 54751-7003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669477592 | Jeremy S Forster | Pediatrics | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2005-06-16 |
| 1144853169 | Alicia Lorraine Stearns | Physician Assistant | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2020-02-18 |
| 1528604089 | Jessica Rae Alstead | Physician Assistant | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2019-11-20 |
| 1912558651 | Chiara Teresa Kristina Coll Andahazy | Physician Assistant | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2019-09-24 |
| 1306492707 | Mayo Foundation for Medical Education & Research | Durable Medical Equipment & Medical Supplies | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2019-08-13 |
| 1164913406 | Julie Locke | Nurse Practitioner | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2018-05-22 |
| 1962910737 | Tara Marie Bridgeman | Pharmacist | 2321 Stout Rd, Menomonie, WI 54751 | 2018-01-16 |
| 1124535455 | Rachael Lynn Nellessen | Pharmacist | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2018-01-09 |
| 1881106953 | Briana Kenyon | Speech-Language Pathologist | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2017-10-30 |
| 1518478205 | Jenna Ann Frieburg | Occupational Therapist | 2321 Stout Rd, Menomonie, WI 54751 | 2017-10-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154840569 | Ashley Friedenfels | Physical Medicine & Rehabilitation | E4486 290th Avenue, Menomonie, WI 54751 | 2017-09-18 |
| 1215307814 | David Calvin Reimann | Hearing Instrument Specialist | E4584 483rd Avenue, Menomonie, WI 54751 | 2015-09-25 |
| 1790128627 | County of Dunn | Skilled Nursing Facility | 651 Howison Circle, Menominie, WI 54751 | 2013-04-10 |
| 1043653983 | County of Dunn | Skilled Nursing Facility | 658 Howison Circle, Menomonie, WI 54751 | 2013-04-10 |
| 1447519236 | Gentle Dental Care LLC | Dentist | 1813 Wilson St., Menomonie, WI 54751 | 2012-05-14 |
| 1386960193 | Kilimanjaro LLC | Non-emergency Medical Transport (VAN) | 1222 14th Ave E, Menomonie, WI 54751 | 2010-04-19 |
| 1275709180 | Dianne Marie Bennett | Counselor | 1916 2nd St W, Menomonie, WI 54751 | 2008-05-01 |
| 1417136201 | David Gary Hackbarth | Chiropractor | 3120 Schneider Ave E, Suite #5, Menomonie, WI 54751 | 2007-10-29 |
| 1306057336 | Tonia D. Behling | Dental Hygienist | 3375 Kothlow Ave., Suite 40, Menomonie, WI 54751 | 2007-05-24 |
| 1295956282 | Danny Roger Wood | Dentist | 1603 Stout Rd, Menomonie, WI 54751 | 2007-05-01 |
| Find all providers in zip 54751 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184834137 | Brenda A Maloney | Pharmacist | 103 Oak Ave, Menomonie, WI 54751-1363 | 2007-05-22 |
| 1598987059 | Jeff S Sorenson | Pharmacist | 149 Main St E, Menomonie, WI 54751-2514 | 2007-05-03 |
| 1659593424 | Frederick Andrew Ochs Jr. | Pharmacist | 1232 Broadway St N, Menomonie, WI 54751-1517 | 2007-05-02 |
| 1265587265 | James D. Wahl | Pharmacist | 1508 9th St E, Menomonie, WI 54751-3430 | 2007-01-23 |
| 1598363152 | Heidi Swartz | Pharmacist | 180 Cedar Falls Rd, Menomonie, WI 54751-1268 | 2020-10-15 |
| 1952909418 | Daniel Allen Schoen | Pharmacist | 180 Cedar Falls Rd, Menomonie, WI 54751-1268 | 2020-10-15 |
| 1598390882 | Seok Yeong Kim | Pharmacist | 433 Broadway St S, Menomonie, WI 54751-1822 | 2020-03-06 |
| 1720612351 | Anthony Michael Schumacher | Pharmacist | 121 Pine Ave W, Menomonie, WI 54751-1311 | 2020-02-21 |
| 1962910737 | Tara Marie Bridgeman | Pharmacist | 2321 Stout Rd, Menomonie, WI 54751 | 2018-01-16 |
| 1124535455 | Rachael Lynn Nellessen | Pharmacist | 2321 Stout Rd, Menomonie, WI 54751-7003 | 2018-01-09 |
| Find all providers in MENOMONIE | ||||
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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.