Provider Demographics
NPI:1932133147
Name:MCMAHON, SIOBHAN KATHLEEN (RN NP)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:KATHLEEN
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:SIOBHAN
Other - Middle Name:KATHLEEN
Other - Last Name:MCAVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:ESSENTIA HEALTH 3RD STREET BUILDING
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-1216
Mailing Address - Fax:
Practice Address - Street 1:400 E 3RD ST
Practice Address - Street 2:ESSENTIA HEALTH 3RD STREET BUILDING
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-1216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1838-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN054449300Medicaid
MN500003343Medicare PIN
MN054449300Medicaid
MNP00284560Medicare PIN