Provider Demographics
NPI:1447225164
Name:BEBENSEE, SHIRLEY LEE (NP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LEE
Last Name:BEBENSEE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:1430 HIGHWAY 96 EAST
Practice Address - Street 2:HEALTHPARTNERS WHITE BEAR LAKE CLINIC
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110
Practice Address - Country:US
Practice Address - Phone:651-426-1980
Practice Address - Fax:651-653-2111
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN0527392363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN403242000Medicaid
MN500001546Medicare ID - Type Unspecified
MN403242000Medicaid