Healthcare Provider Details

I. General information

NPI: 1104647395
Provider Name (Legal Business Name): CALIE SHEMWELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LAGOON AVE
MINNEAPOLIS MN
55408-2077
US

IV. Provider business mailing address

1006 PINE ST W
STILLWATER MN
55082-5647
US

V. Phone/Fax

Practice location:
  • Phone: 888-251-8192
  • Fax:
Mailing address:
  • Phone: 952-334-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number12151
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: