Healthcare Provider Details

I. General information

NPI: 1144151374
Provider Name (Legal Business Name): SHAWNA RENAE BRASGALLA WENDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MAIN AVE S
BAUDETTE MN
56623-2855
US

IV. Provider business mailing address

783 COUNTY ROAD 6 NW
BAUDETTE MN
56623-8867
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-3403
  • Fax:
Mailing address:
  • Phone: 218-634-3403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: