Provider Demographics
NPI:1578946885
Name:GRIFFIN, SHAWNA JO (FNP)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:JO
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:235 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024-4117
Mailing Address - Country:US
Mailing Address - Phone:715-483-3221
Mailing Address - Fax:715-483-0507
Practice Address - Street 1:12375 LINDSTROM LN
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9551
Practice Address - Country:US
Practice Address - Phone:651-400-2240
Practice Address - Fax:715-483-0507
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI14493-33363LF0000X
MNCNP 3877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily