Healthcare Provider Details

I. General information

NPI: 1740683416
Provider Name (Legal Business Name): SHANNON PATRICIA ANDERSON APRN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON PATRICIA SCHMITZ

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 6TH AVE N ST CLOUD HOSPITAL
SAINT CLOUD MN
56303-1900
US

IV. Provider business mailing address

1406 6TH AVE N ST CLOUD HOSPITAL
SAINT CLOUD MN
56303-1900
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-2700
  • Fax: 320-656-7115
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR196543-2
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR196543-2
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1965432
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP2962
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: