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General NPI Number Information
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NPI Number | 1740683416
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Entity Type | Individual
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Provider Name | SHANNON PATRICIA ANDERSON APRN CNP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 11/25/2015
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Provider Practice Location Address
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Address Line | 1406 6TH AVE N ST CLOUD HOSPITAL
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1900
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Country | US
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Telephone | 320-251-2700
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Fax | 320-656-7115
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Provider Business Mailing Address
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Address Line | 1406 6TH AVE N ST CLOUD HOSPITAL
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1900
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Country | US
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Telephone | 320-251-2700
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Fax | 320-656-7115
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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 | 364SP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | R196543-2
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R196543-2
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R1965432
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP2962
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License Number State | MN
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