MEDICARE: SHAWN MARIE WHELAN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2812	MN

General Provider Information

NPI Number	:	1134317704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN MARIE WHELAN CNP

Provider Business Mailing Address
First Line	:	901 S 2ND ST STE A
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-2123
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S 2ND ST STE A
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55415-2123
Country	:	US
Telephone Number	:	612-338-1383
Fax Number	:	612-339-1890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	01/09/2020

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