Basic Information
Provider Information
NPI: 1003800517
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARTHOLOW
FirstName: SHERYL
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: REESE
OtherFirstName: SHERYL
OtherMiddleName: MARIE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MSN
OtherLastNameType: 1
Mailing Information
Address1: 1805 HENNEPIN AVE N
Address2:  
City: GLENCOE
State: MN
PostalCode: 55336
CountryCode: US
TelephoneNumber: 3208643121
FaxNumber: 3208647887
Practice Location
Address1: 1805 HENNEPIN AVE N
Address2:  
City: GLENCOE
State: MN
PostalCode: 55336
CountryCode: US
TelephoneNumber: 3208643121
FaxNumber: 3208647887
Other Information
ProviderEnumerationDate: 09/12/2005
LastUpdateDate: 12/15/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XR105634-1MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XR1056341MNN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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