| Doctor Name: | SHANNON N SIEKAS |
| NPI Number: | 1003222597 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 179217-1 |
| Business Practice Address: | 13060 Isle Dr Baxter, MN - 564258331 |
| Business Phone Number: | 2188282880 |
| Business Fax Number: | |
| Mailing Address: | 523 N 3rd St, BRAINERD |
| State: | MN |
| Postal Code: | 564013054 |
| Phone Number: | 2188282880 |
| Fax Number: | 2184545916 |
| NPI Enumeration Date: | 07/07/2014 |
| NPI Last Update Date: | 01/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 179217-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |