Most Relevant Information
Provider Data
| NPI Number: | 1003222597 |
| Provider Name: | SHANNON N SIEKAS |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 179217-1 |
Most Important Dates
| Enumeration Date: | 07/07/2014 |
| Last Updated: | 01/15/2016 |
Provider Practice Location
13060 ISLE DR
BAXTER
MN
564258331
Practice Location Phone/Fax
| Phone: | 2188282880 |
| Fax: |
Provider Mailing Location
523 N 3RD ST
BRAINERD
MN
564013054
Provider Mailing Phone/Fax
| Phone: | 2188282880 |
| Fax: | 2184545916 |