Individual
SHANNON MARIE RISTAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2115 SUMMIT AVE, LORAS HALL 406, SAINT PAUL, MN 55105-1048
(503) 396-2896
Mailing address
1776 SAINT CLAIR AVE, APT #407, SAINT PAUL, MN 55105-1962
(651) 690-0177
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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