Individual
SHANNON JEAN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
400 E 3RD ST, DULUTH, MN 55805-1951
(218) 786-8364
Mailing address
400 EAST THIRD STREET, MCL2CRED, DULUTH, MN 55805-1951
(218) 786-3146
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R1433638-5
MN
363L00000X
Nurse Practitioner
R32669
ND
363LF0000X
Family Nurse Practitioner
Primary
3280
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19873
—
ND
05
—
408164100
—
MN
Enumeration date
01/03/2006
Last updated
10/24/2018
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