Healthcare Provider Details

I. General information

NPI: 1124442934
Provider Name (Legal Business Name): SHARI VANBRIESEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MCKINNEY AVE
BENSON MN
56215-1638
US

IV. Provider business mailing address

1810 MCKINNEY AVE
BENSON MN
56215-1638
US

V. Phone/Fax

Practice location:
  • Phone: 320-843-2030
  • Fax: 320-843-4806
Mailing address:
  • Phone: 320-843-2030
  • Fax: 320-843-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR1344901
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: