SHANNON TABAKA SW NPI 1992680615

NPI Information

  • NPI: 1992680615
  • Provider Name: SHANNON TABAKA, SW
  • Classification: Lodging - 177F00000X
  • Entity Type: Individual
  • Address: 12714 FREMONT AVE
    ZIMMERMAN, MN
    ZIP 55398
  • Phone: (763) 732-2065

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NPI Details

Shannon Tabaka, SW is a lodging in Zimmerman, MN. The provider is a public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home. Shannon Tabaka, SW NPI is 1992680615. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

12714 FREMONT AVE
ZIMMERMAN, MN
ZIP 55398-406
Phone: (763) 732-2065

The enumeration date for this NPI number is 8/11/2025 and was last updated on 8/11/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1177F00000XLodgingFBL4413164383MINNESOTAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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