Individual
SHELBY MARYANN MODEROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7321 BALMER ST # 570, HILL AFB, UT 84056-5012
(801) 586-2273
Mailing address
1425 5TH ST N, FARGO, ND 58102-2734
(701) 371-3519
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
09/14/2022
Last updated
09/14/2022
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