Healthcare Provider Details

I. General information

NPI: 1154145035
Provider Name (Legal Business Name): SHANNON KATHLEEN SWIONTEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON KATHLEEN WELSH LPN

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 8TH ST W
WEST FARGO ND
58078-4072
US

IV. Provider business mailing address

2101 ELM ST N
FARGO ND
58102-2417
US

V. Phone/Fax

Practice location:
  • Phone: 701-793-6051
  • Fax:
Mailing address:
  • Phone: 701-232-3241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR43973
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: