Healthcare Provider Details

I. General information

NPI: 1528350667
Provider Name (Legal Business Name): SHAWN LEE WEBSTER CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16412 TALL PINES LN
MERRIFIELD MN
56465-4080
US

IV. Provider business mailing address

16412 TALL PINES LN
MERRIFIELD MN
56465-4080
US

V. Phone/Fax

Practice location:
  • Phone: 218-296-0383
  • Fax:
Mailing address:
  • Phone: 218-296-0383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12779
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR170566-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: