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General NPI Number Information
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NPI Number | 1023456456
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Entity Type | Individual
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Provider Name | SHAUN TERRANCE OKEEFE PAC, MPAS
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Gender | Male
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 235 E STATE ST
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City | SAINT CROIX FALLS
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State | WI
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Zip | 54024-4117
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Country | US
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Telephone | 715-483-3261
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Fax | 715-483-0507
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Provider Business Mailing Address
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Address Line | 235 E STATE ST
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City | SAINT CROIX FALLS
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State | WI
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Zip | 54024-4117
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Country | US
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Telephone | 715-483-3261
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Fax | 715-483-0507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11410
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3131-23
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License Number State | WI
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