Active NPI
Shari Lynn Kvidahl, BSN-RN
- Registered Nurse
- Cedar Rapids, IA
National Provider Identifier
1912679655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 143111
- Practice address
- 1615 Grande Ave SE
Cedar Rapids, IA 52403-2221 - Phone
- (319) 777-4311
- NPI assigned
- Sep 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Infusion Therapy Registered Nurse | 163WI0500X | 143111 | IA | |
| Wound Care Registered Nurse | 163WW0000X | 143111 | IA | |
| Registered Nurse | 163W00000X | 143111 | IA | Primary |
Addresses
Primary practice location
1615 Grande Ave SE
Cedar Rapids, IA 52403-2221
Mailing address
1615 Grande Ave SE
Cedar Rapids, IA 52403-2221
Phone (319) 777-4311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 143111 | Other | IA | COMPACT NURSING LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CR Infusion Specialists | Wound Care | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632960000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632960000000",
"number": "1912679655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1615 GRANDE AVE SE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524032221",
"telephone_number": "319-777-4311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1615 GRANDE AVE SE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524032221",
"telephone_number": "319-777-4311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KVIDAHL",
"first_name": "SHARI",
"middle_name": "LYNN",
"credential": "BSN-RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-30",
"last_updated": "2021-09-30",
"certification_date": "2021-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "163WI0500X",
"taxonomy_group": "",
"desc": "Registered Nurse, Infusion Therapy",
"state": "IA",
"license": "143111",
"primary": false
},
{
"code": "163WW0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, Wound Care",
"state": "IA",
"license": "143111",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IA",
"license": "143111",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMPACT NURSING LICENSE NUMBER",
"identifier": "143111",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.