Shannon Marie Kruckeberg
Dental Hygienist
63407 130th Ave
Claremont
, Minnesota 55924-4656
Shannon Marie Kruckeberg
Dental Hygienist
63407 130th Ave
Claremont
, Minnesota 55924-4656
(507) 319-6845
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About
Features
Specialties
- Dental Hygienist
Languages spoken
- English
Location
First Address
- Shannon Marie Kruckeberg
- 63407 130th Ave
- Claremont, MN
- Zip : 55924-4656
- Phone : (507) 319-6845
Second Address
- Shannon Marie Kruckeberg
- 63407 130th Ave
- Claremont, MN
- Zip : 55924-4656
- Phone : (507) 319-6845
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | H6343 | MN |
National Provider Identifier
| NPI | 1003002882 |
|---|---|
| Provider Name | Shannon Marie Kruckeberg |
| First Address | Claremont, MN 55924-4656 |
| Second Address | Claremont, MN 55924-4656 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 14/09/2007 |
| Last Update Date | 16/11/2009 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.