Shelley Jean Jacobson

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

R26493 Issued in ND

Practice address

6960 County Road 17
Bowbells, ND 58721-9418

Phone

(701) 377-2122

Fax

(701) 377-2122

NPI assigned

Sep 14, 2018

Last updated

Sep 14, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536883200000",
    "number": "1205319225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6960 COUNTY ROAD 17",
            "city": "BOWBELLS",
            "state": "ND",
            "postal_code": "587219418",
            "telephone_number": "701-377-2122",
            "fax_number": "701-377-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6960 COUNTY ROAD 17",
            "city": "BOWBELLS",
            "state": "ND",
            "postal_code": "587219418",
            "telephone_number": "701-377-2122",
            "fax_number": "701-377-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBSON",
        "first_name": "SHELLEY",
        "middle_name": "JEAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-14",
        "last_updated": "2018-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "ND",
            "license": "R26493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savannah Baltrusch
• Bowbells Ambulance Service
• Burke County Social Services
• Northland Health Centers
• St. Luke's Hospital (Bowbells Clinic)

• General Practice Registered Nurse in Bowbells, ND
• Providers in Bowbells, ND by specialty
• General Practice Registered Nurse in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.