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Individual
SHANNON LYNN BACKSTROM
Active
Individual
SHANNON LYNN BACKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
363LP1700X
Perinatal Nurse Practitioner
Primary
CP000442
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0407827
MEDICA
SD
05
—
0503706
—
IA
05
—
10025040700
—
NE
01
—
2387949
ARAZ/ AMERICA'S PPO
SD
01
—
248007
BLUE CROSS
SD
01
—
283761045259
PREFERRED ONE
SD
01
—
370624200
DEPT OF LABOR
SD
05
—
400070600
—
MN
01
—
57105AD05
WPS TRICARE
SD
05
—
6828300
—
SD
05
—
6828302
—
SD
01
—
83G56BE
CC SYSTEMS/ BLUE PLUS
MN
01
—
924114229808
PRIMEWEST
MN
01
—
9244760
DAKOTACARE
SD
01
—
HP55697
HEALTHPARTNERS
SD
Enumeration date
02/07/2006
Last updated
10/10/2018
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