Healthcare Provider Details

I. General information

NPI: 1548245012
Provider Name (Legal Business Name): SHANNON J SCHWAB DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON J KOWAL DO

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 LOOKOUT DR
NORTH MANKATO MN
56003-2503
US

IV. Provider business mailing address

PO BOX 8674
MANKATO MN
56002-8674
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-8111
  • Fax: 507-625-6282
Mailing address:
  • Phone: 507-625-1811
  • Fax: 507-625-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40982
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ5925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: