Provider Demographics
NPI:1578142782
Name:EMHOFF, SHANNON LEA
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEA
Last Name:EMHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 2ND ST S
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4707
Mailing Address - Country:US
Mailing Address - Phone:701-680-9722
Mailing Address - Fax:
Practice Address - Street 1:213 2ND ST S
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4707
Practice Address - Country:US
Practice Address - Phone:701-680-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant