Individual
SHELLEY D OVERHOLT-THIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
320 EAST MAIN STREET, CUYUNA REGIONAL MEDICAL CENTER, CROSBY, MN 56441
(218) 546-7000
(218) 546-4400
Mailing address
320 EAST MAIN STREET, CROSBY, MN 56441
(218) 546-7000
(218) 546-4400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
04-29239
KS
207Q00000X
Family Medicine Physician
Primary
57858
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100404310A
—
KS
01
—
57858
MN LICENSE
MN
Enumeration date
04/12/2006
Last updated
03/26/2015
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