Healthcare Provider Details

I. General information

NPI: 1619894847
Provider Name (Legal Business Name): SHAWNNA HALL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 WIECKING CTR
MANKATO MN
56001-6062
US

IV. Provider business mailing address

2584 HORSESHOE LN
WOODBURY MN
55125-9586
US

V. Phone/Fax

Practice location:
  • Phone: 507-389-1866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14406
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: