National Provider Identifier Database

SHANNON L BACKSTROM, CNP – NPI #1093787616
Perinatal

Contact Information

SHANNON L BACKSTROM, CNP
1417 S. CLIFF AVE.
STE. 100
SIOUX FALLS, SD  57105-1063
Phone: 605-322-8937
Fax: 605-322-8938
Website:
Specialty Taxonomy Code
* Perinatal 363LP1700X

* Indicates primary specialty

NPI Profile & details for SHANNON L BACKSTROM

NPI Number 1093787616
Credentials CNP (Certified Nurse Practitioner)
Entity Individual
Enumeration date 02/07/2006
Last updated 10/10/2018 - About 8 years ago
Sole proprietor1 No
Identifiers
  • SD License #: CP000442
  • IA Medicaid: 0503706
  • MN Medicaid: 400070600
  • NE Medicaid: 10025040700
  • SD Medicaid: 6828300
  • SD Medicaid: 6828302
  • MN Other: 83G56BE BLUE CROSS
  • MN Other: 83G56BE CC SYSTEMS/ BLUE PLUS
  • MN Other: 924114229808 PRIMEWEST
  • SD Other: 2387949 ARAZ/ AMERICA'S PPO
  • SD Other: 248007 BLUE CROSS
  • SD Other: 9244760 DAKOTACARE
  • SD Other: 370624200 DEPT OF LABOR
  • SD Other: HP55697 HEALTHPARTNERS
  • SD Other: 0407827 MEDICA
  • SD Other: 248007 MIDLANDS CHOICE
  • SD Other: 283761045259 PREFERRED ONE
  • SD Other: 57105AD05 WPS TRICARE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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