Most Relevant Information
Provider Data
| NPI Number: | 1003438037 |
| Provider Name: | SHANNON MARIE HACKA |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/13/2020 |
| Last Updated: | 05/13/2020 |
Provider Practice Location
1011 MEADOWLANDS DR STE 1&2
SAINT PAUL
MN
551272339
Practice Location Phone/Fax
| Phone: | 5073227752 |
| Fax: |
Provider Mailing Location
1680 WESTMINSTER ST
SAINT PAUL
MN
551303039
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |