IndividualActive
Shannon Tabaka, SW
NPI 1992680615 · Lodging Provider · Zimmerman, MN
Provider details
- NPI number
- 1992680615
- Entity type
- Individual
- Primary specialty
- Lodging ProviderOther Service Providers
- Credential
- SW
- Sex
- Female
- Sole proprietor
- Yes
- License
- FBL4413164383 (MN)
Specialties & taxonomies
Other Service Providers
Practice location
12714 Fremont Ave
Zimmerman, MN 55398-9406
Phone: (763) 732-2065
Approximate (ZIP-level) locationGet directions
Mailing address
6314 Cedar Rd
Oak Park, MN 56357-8529
Registry dates
- Enumerated
- 2025-08-11
- Last updated
- 2025-08-11
- Certified
- 2025-08-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.