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Individual

DJANINN MAE SHANNON MCKIBBEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
222 N 7TH ST, BISMARCK, ND 58501-4436
(701) 323-6000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
11613
MN
363A00000X
Physician Assistant
Primary
PAC0687
ND

Other

Enumeration date
06/19/2014
Last updated
02/22/2023
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