Provider Demographics
NPI:1215788237
Name:BATES, SHANNON MARGARET (FNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARGARET
Last Name:BATES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-3129
Mailing Address - Country:US
Mailing Address - Phone:612-210-8621
Mailing Address - Fax:
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 143N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1098
Practice Address - Country:US
Practice Address - Phone:651-642-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner