Provider Demographics
NPI:1184668147
Name:PERRON, SHANNON M (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:PERRON
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 FRANCE AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-3400
Mailing Address - Country:US
Mailing Address - Phone:952-835-1311
Mailing Address - Fax:952-863-1077
Practice Address - Street 1:7500 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-3400
Practice Address - Country:US
Practice Address - Phone:952-835-1311
Practice Address - Fax:952-863-1077
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1991163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN855257OtherREGISTERED DIETITIAN
MN1991OtherLICENSE