Individual
MRS. SHANNON RAE TIMMERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
6636 CEDAR AVE S, RICHFIELD, MN 55423-2705
(612) 467-5719
Mailing address
6636 CEDAR AVE S, RICHFIELD, MN 55423-2705
(612) 467-5719
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A104267
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0433078
—
IA
Enumeration date
04/04/2006
Last updated
12/09/2022
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