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NPI Code Detail

MEDICARE: GAYLE SHANNON CARNEY LSW

MEDICARE: GAYLE SHANNON CARNEY LSW
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
1171M00000XCase Manager/Care Coordinator10928MN

General Provider Information

NPI Number : 1649504127
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAYLE SHANNON CARNEY LSW
Provider Business Mailing Address
First Line : 317 YORK AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55130-4039
Country : US
Telephone Number : 651-774-0011
Fax Number : 651-774-0606
Provider Business Practice Location Address
First Line : 317 YORK AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55130-4039
Country : US
Telephone Number : 651-774-0011
Fax Number : 651-774-0606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2009
Last Update Date : 09/30/2009

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Directions to “ GAYLE SHANNON CARNEY LSW” Practice Location

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