Individual
MS. SHANNA LORRAINE BICKNASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1301 12TH AVE N, FARGO, ND 58102-3400
(701) 231-8011
Mailing address
4238 9TH AVE S APT 108, FARGO, ND 58103-2068
(605) 201-6492
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
308-06
ND
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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