Active NPI
Shannon N Siekas
- Family Nurse Practitioner
- Baxter, MN
National Provider Identifier
1003222597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 179217-1
- Practice address
- 13060 Isle Dr
Baxter, MN 56425-8331 - Phone
- (218) 828-2880
- NPI assigned
- Jul 7, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 179217-1 | MN | Primary |
Addresses
Primary practice location
13060 Isle Dr
Baxter, MN 56425-8331
Mailing address
523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-2880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1792171 | Other | MN | MN BOARD OF NURSING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 179217-1 | MN | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452816000000",
"number": "1003222597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "523 N 3RD ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013054",
"telephone_number": "218-828-2880",
"fax_number": "218-454-5916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13060 ISLE DR",
"city": "BAXTER",
"state": "MN",
"postal_code": "564258331",
"telephone_number": "218-828-2880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIEKAS",
"first_name": "SHANNON",
"middle_name": "N",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-07",
"last_updated": "2016-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MN",
"license": "179217-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BOARD OF NURSING",
"identifier": "1792171",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baxter, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.