Provider Demographics
NPI:1366239808
Name:BASTIAN-COLEMAN, SHATASHA (CNA)
Entity type:Individual
Prefix:
First Name:SHATASHA
Middle Name:
Last Name:BASTIAN-COLEMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 2ND AVE SW APT 1
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3456
Mailing Address - Country:US
Mailing Address - Phone:701-340-1288
Mailing Address - Fax:
Practice Address - Street 1:2109 2ND AVE SW APT 1
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3456
Practice Address - Country:US
Practice Address - Phone:701-340-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND148954376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No376K00000XNursing Service Related ProvidersNurse's Aide