Provider Demographics
NPI:1780143453
Name:DUWENHOEGGER, SHARI BERNICE
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:BERNICE
Last Name:DUWENHOEGGER
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 1:9037 GARLAND LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1285
Mailing Address - Country:US
Mailing Address - Phone:612-481-5629
Mailing Address - Fax:
Practice Address - Street 1:9037 GARLAND LN N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1285
Practice Address - Country:US
Practice Address - Phone:612-481-5629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL59057-8164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse