Provider Demographics
NPI:1457939563
Name:NORDMANN, SHELBY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:NORDMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:
Other - Last Name:ROLFHUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 WINN DR
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-5277
Mailing Address - Country:US
Mailing Address - Phone:208-881-5222
Mailing Address - Fax:
Practice Address - Street 1:21 WINN DR
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5277
Practice Address - Country:US
Practice Address - Phone:208-881-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-17392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine