Individual
SHANNON TABAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SW
Contact information
Practice address
12714 FREMONT AVE, ZIMMERMAN, MN 55398-9406
(763) 732-2065
Mailing address
6314 CEDAR RD, OAK PARK, MN 56357-8529
(763) 732-2065
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
FBL4413164383
MN
Other
Enumeration date
08/11/2025
Last updated
08/11/2025
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