Healthcare Provider Details

I. General information

NPI: 1508375809
Provider Name (Legal Business Name): SHANNON MARIE PIONK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 FELTL ROAD
MINNETONKA MN
55343-7983
US

IV. Provider business mailing address

5435 FELTL RD
MINNETONKA MN
55343-7983
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-9880
  • Fax: 952-857-1554
Mailing address:
  • Phone: 952-835-9880
  • Fax: 952-857-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09171415
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: