Provider Demographics
NPI:1912355025
Name:BICE, SHANNON (RN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 JOHNSON AVE SW
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2539
Mailing Address - Country:US
Mailing Address - Phone:507-835-0689
Mailing Address - Fax:
Practice Address - Street 1:299 JOHNSON AVE SW
Practice Address - Street 2:SUITE 160
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2539
Practice Address - Country:US
Practice Address - Phone:507-835-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-164995-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41-6005917OtherWASECA COUNTY PUBLIC HEALTH