SHELLY JOAN MYROM (NPI# 1508884917) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508884917 |
| Entity Type | Individual |
| Full Name | SHELLY JOAN MYROM |
| Other Name | SHELLY JOAN MYROM |
| Credential | CNP |
| Practice Address |
300 State Ave Faribault MN 55021 |
| Mailing Address |
300 State Ave Faribault MN 55021-6319 |
| Practice Telephone | 5073333300 |
| Practice Fax Number | 5073333214 |
| Mailing Telephone | 5073333300 |
| Mailing Fax Number | 5073333214 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-09-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 1378 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | R0848026 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 924 1st St Ne, Faribault, MN 550215441 | 5073333300 | 5073333214 |
| Street Address |
300 STATE AVE |
| City | FARIBAULT |
| State | MN |
| Zip Code | 55021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629071675 | Alex Sneiders | Specialist | 300 State Ave, Faribault, MN 55021-6319 | 2005-05-23 |
| 1215540810 | Bauj S Yang | Nurse Practitioner | 300 State Ave, Faribault, MN 55021-6319 | 2020-08-25 |
| 1013541408 | Kris Lee Dutton | Specialist/Technologist | 300 State Ave, Faribault, MN 55021-6319 | 2020-02-25 |
| 1073040838 | Mayo Clinic Health System-southeast Minnesota Region | Durable Medical Equipment & Medical Supplies | 300 State Ave, Faribault, MN 55021-6319 | 2017-05-11 |
| 1457779563 | Brian Igoni Wariboko | Family Medicine | 300 State Ave, Faribault, MN 55021-6319 | 2014-04-04 |
| 1003077223 | Jason Allen Lee | Physical Medicine & Rehabilitation | 300 State Ave, Faribault, MN 55021-6319 | 2008-06-19 |
| 1730264037 | James Layne Moore | Psychiatry & Neurology | 300 State Ave, Faribault, MN 55021-6319 | 2006-10-26 |
| 1649204645 | Judy Lynn Fruehbrodt-glenzinski | Family Medicine | 300 State Ave, Faribault, MN 55021 | 2006-07-10 |
| 1134169246 | Jory M Burroughs | Obstetrics & Gynecology | 300 State Ave, Faribault, MN 55021-6319 | 2006-06-07 |
| 1164400057 | Travis L Roethler | Physician Assistant | 300 State Ave, Faribault, MN 55021-6319 | 2006-01-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872831 | Kent William Lundstrom | Pharmacist | 612 4th Street Nw, Faribault, MN 55021 | 2020-08-19 |
| 1053957357 | M&t Sisters of Serendipity Pllc | Counselor | 212a Centralave, Faribault, MN 55021 | 2019-11-21 |
| 1639720485 | Reliable Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 200 8th Avenue Nw, Faribault, MN 55021 | 2019-09-24 |
| 1235663428 | Tanya Borchert | Social Worker | 100 State Avenue, Faribault, MN 55021 | 2017-04-14 |
| 1235589854 | Bashir Omar I | Interpreter | 2426 Park Ave # 309, Faribault, MN 55021 | 2016-06-14 |
| 1790150381 | Rainbow United Care Transportation LLC | Non-emergency Medical Transport (VAN) | 1738 Patrick Bay, Faribault, MN 55021 | 2015-12-08 |
| 1740625938 | Steven James Klapmeier | Family Medicine | 1101 Linden Lane, Mcfffrb Health Service, Faribault, MN 55021 | 2013-05-02 |
| 1528306040 | Discovery Public School of Faribault | Local Education Agency (LEA) | 126 8th St. Nw, Faribault, MN 55021 | 2013-01-17 |
| 1164790374 | Emmanuel Douah | Pharmacist | 612 4th Avenue Nw, Faribault, MN 55021 | 2011-12-02 |
| 1770873937 | Faribault Senior Living LLC | Assisted Living Facility | 843 Faribault Road, Faribault, MN 55021 | 2011-04-08 |
| Find all providers in zip 55021 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255731220 | Michelle Crosby | Nurse Practitioner | 100 State Ave, Faribault, MN 55021-6337 | 2014-08-27 |
| 1366728636 | Michelle Denise Torgersen | Nurse Practitioner | 200 State Ave, Faribault, MN 55021-6339 | 2011-10-31 |
| 1427364322 | Stephanie M Arendt | Nurse Practitioner | 100 State Ave, Faribault, MN 55021-6337 | 2010-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841803970 | Kelsey Olson | Nurse Practitioner | 2450 Riverside Ave Fl 9, Minneapolis, MN 55454-1450 | 2020-08-28 |
| 1043821622 | Byron Howard Herdman | Nurse Practitioner | 20671 State Highway 29, Henning, MN 56551-9521 | 2020-08-16 |
| 1568071058 | Miranda Bea Irene Charley | Nurse Practitioner | 510 Water St E, Cannon Falls, MN 55009-1643 | 2020-07-30 |
| 1861001059 | Angelsisters Home Healthcare Servies LLC | Nurse Practitioner | 10001 Butternut Cir N, Brooklyn Park, MN 55443-1864 | 2020-07-24 |
| 1720606544 | Kendra Marie Robida | Nurse Practitioner | 7245 Guider Dr Apt 317, Woodbury, MN 55125-5358 | 2020-07-08 |
| 1568089340 | Emily Abernethy | Nurse Practitioner | 1001 E Superior St Ste 401, Duluth, MN 55802-2229 | 2020-06-29 |
| 1487276556 | Kerriann Godwin | Nurse Practitioner | 842 102nd Ln Ne, Blaine, MN 55434-2642 | 2020-05-12 |
| 1699397851 | School of Health LLC | Nurse Practitioner | 30165 Terryll St, Lindstrom, MN 55045-9310 | 2020-05-11 |
| 1255953626 | Carla Renea Boudoir | Nurse Practitioner | 18342 Kerrville Trl, Lakeville, MN 55044-7310 | 2020-05-08 |
| 1639799745 | Elizabeth Carole Moe | Nurse Practitioner | 2151 Troop Dr, Sartell, MN 56377-4563 | 2020-04-17 |
| Find all providers with the same taxonomy | ||||
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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.