MEDICARE: SHAWN LEE WEBSTER CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	12779	MN
2	163WR0006X	Registered Nurse First Assistant	R170566-3	MN

General Provider Information

NPI Number	:	1528350667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN LEE WEBSTER CNP

Provider Business Mailing Address
First Line	:	16412 TALL PINES LN
Second Line	:
City	:	MERRIFIELD
State	:	MN
Zip	:	56465-4080
Country	:	US
Telephone Number	:	218-296-0383
Fax Number	:

Provider Business Practice Location Address
First Line	:	16412 TALL PINES LN
Second Line	:
City	:	MERRIFIELD
State	:	MN
Zip	:	56465-4080
Country	:	US
Telephone Number	:	218-296-0383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2011
Last Update Date	:	04/01/2026

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