=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578946885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAWNA JO GRIFFIN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2015
-----------------------------------------------------
Last Update Date | 11/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12375 LINDSTROM LN
-----------------------------------------------------
City | LINDSTROM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55045-9551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-400-2240
-----------------------------------------------------
Fax | 715-483-0507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 235 E STATE ST
-----------------------------------------------------
City | SAINT CROIX FALLS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54024-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-483-3221
-----------------------------------------------------
Fax | 715-483-0507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 14493-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP 3877
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------