Basic Information
| Provider Information | |||||||||
| NPI: | 1578536728 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERSTRIEP | ||||||||
| FirstName: | SHELBY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5074 | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175074 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 820 4 STREET NORTH | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 58122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012342397 | ||||||||
| FaxNumber: | 7012343861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 11/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 44845 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | 10689 | ND | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | 10689 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0T949TE | 01 | MN | MN BCBS | OTHER | 1052299 | 01 | PREFERREDONE | OTHER | 14402 | 05 | ND | MEDICAID | 28864 | 01 | ND | ND BCBS | OTHER | 3600840 | 01 | MEDICA | OTHER | 350433600 | 05 | MN | MEDICAID | HEALTHPARTNERS | 01 | HP62138 | OTHER |