| Doctor Name: | SHANNON WHALEY |
| NPI Number: | 1780026419 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | R1740327 |
| Business Practice Address: | 1900 Silver Lake Rd Nw Suite 110 New Brighton, MN - 551121786 |
| Business Phone Number: | 6516289566 |
| Business Fax Number: | 6516280411 |
| Mailing Address: | 1900 Silver Lake Rd Nw, Suite 110 NEW BRIGHTON |
| State: | MN |
| Postal Code: | 551121786 |
| Phone Number: | 6516289566 |
| Fax Number: | 6516280411 |
| NPI Enumeration Date: | 07/23/2013 |
| NPI Last Update Date: | 08/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364S00000X |
| License Number: | R1740327 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. |