Provider Demographics
NPI:1588685820
Name:TWOBEARS, SHANTELL M (MD)
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:M
Last Name:TWOBEARS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 PROFESSIONAL LN UNIT 280
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6965
Mailing Address - Country:US
Mailing Address - Phone:303-773-9000
Mailing Address - Fax:
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 170
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6971
Practice Address - Country:US
Practice Address - Phone:303-773-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN932G4TWOtherBLUE CROSS BLUE SHIELD
HP29359OtherHEALTHPARTNERS
ND10470Medicaid
01-26972OtherMEDICA
ND28202OtherBLUE CROSS BLUE SHIELD
B20861015426OtherPREFERRED ONE
ND28202OtherBLUE CROSS BLUE SHIELD
ND10470Medicaid