Roth, Shannon Jean

Roth, Shannon Jean is an individual health care provider with primary practice located at 400 E 3Rd St , Duluth MN 55805-1951. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Roth, Shannon Jean can be contacted via phone (218) 786-8364.

Contact Information

Primary practice address
400 E 3Rd St Duluth MN 55805-1951
Phone: (218) 786-8364
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 3280 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R1433638-5 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R32669 North Dakota

Profile Details

NPI number 1144208976
LBN Legal business name Roth, Shannon Jean
Credentials APRN, CNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 3rd, 2006
Last updated Oct 24th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144208976 NPPES
Minnesota MEDICAID 408164100
Minnesota MEDICAID 19873

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