Shirley Ann Nicholson
Individual provider Active NPI Community Health Worker · Two Harbors, MN
NPI 1760623771 · NPPES record last updated Mar 20, 2009
Key facts
- NPI
- 1760623771
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- License
- 230534-1-AFC (MN)
- Practice address
- 307 2ND Ave
Two Harbors, MN 55616-1619 - Phone
- (218) 834-2172
- Fax
- (218) 834-2172
- NPI assigned
- Mar 20, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 230534-1-AFC | MN | MD | Community Health Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 230534-1-AFC | MN | Yes |
Addresses
Primary practice location
307 2ND Ave
Two Harbors, MN 55616-1619
Mailing address
307 2ND Ave
Two Harbors, MN 55616-1619
Phone (218) 834-2172
Other providers in Two Harbors, MN
- Michelle L Miller
- Terry Lynn Moen
- Victoria Ruth Morrison
- Cassandra Jo Morsette
- Suzanne Elizabeth Myers
- Edwin Eugene Niemi
- North Shore Dental Limited
- Christine Mari Oliver-Kneebone
- Lee T Olson
- Paul M Trygstad
All providers in Two Harbors, MN · Community Health Worker in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.