Individual
MISS SHANNON MARIE BUCKMIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3244 51ST ST S, FARGO, ND 58104-7179
(013) 565-4127
(701) 356-5412
Mailing address
3244 51ST ST S, FARGO, ND 58104-7179
(013) 565-4127
(701) 356-5412
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251P0200X
Pediatric Physical Therapist
6742
MN
2251P0200X
Pediatric Physical Therapist
980
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25303
BLUE CROSS BLUE SHIELD
ND
05
—
54984
—
ND
01
—
64-05521
MEDICA-UNITED HEALTH CARE
—
05
—
736122000
—
MN
01
—
9378588
PRIVATE HEALTHCARE SYSTEM
—
01
—
HP50727
HEALTH PARTNERS
—
Enumeration date
01/03/2007
Last updated
04/30/2025
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