Provider Demographics
NPI:1588957757
Name:PATNAUDE, SHELLY ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:ANN
Last Name:PATNAUDE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 SARAZIN ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4332
Mailing Address - Country:US
Mailing Address - Phone:612-382-2871
Mailing Address - Fax:
Practice Address - Street 1:752 SARAZIN ST
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4332
Practice Address - Country:US
Practice Address - Phone:612-382-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-22
Last Update Date:2011-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56815-7164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse