Individual
SHANNON N SIEKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13060 ISLE DR, BAXTER, MN 56425-8331
(218) 828-2880
Mailing address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 828-2880
(218) 454-5916
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
179217-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1792171
MN BOARD OF NURSING
MN
Enumeration date
07/07/2014
Last updated
01/15/2016
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