Provider Demographics
NPI:1780026419
Name:WHALEY, SHANNON (CNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:WHALEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:BRUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:895 7TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3871
Mailing Address - Country:US
Mailing Address - Phone:651-602-7500
Mailing Address - Fax:651-222-1305
Practice Address - Street 1:895 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-3871
Practice Address - Country:US
Practice Address - Phone:651-602-7500
Practice Address - Fax:651-222-1305
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1740327364S00000X
MN655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist