Provider Demographics
NPI:1750606984
Name:KONGSJORD, SHANA KATHLYN (CNP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:KATHLYN
Last Name:KONGSJORD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:KATHLYN
Other - Last Name:FIDELDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 10TH AVE NE
Mailing Address - Street 2:DULUTH CLINIC DEER RIVER
Mailing Address - City:DEER RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:56636-8703
Mailing Address - Country:US
Mailing Address - Phone:218-246-8275
Mailing Address - Fax:
Practice Address - Street 1:1025 10TH AVE NE
Practice Address - Street 2:DULUTH CLINIC DEER RIVER
Practice Address - City:DEER RIVER
Practice Address - State:MN
Practice Address - Zip Code:56636-8703
Practice Address - Country:US
Practice Address - Phone:218-246-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR179908-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily