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SHANNON TABAKA SW
NPI 1992680615
Lodging in Zimmerman, MN

Active since August 11, 2025
12714 FREMONT AVE, ZIMMERMAN, MN 55398(763) 732-2065 Get Directions Write a Review

NPPES record last updated: August 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shannon Tabaka Sw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHANNON TABAKA SW (NPI 1992680615) is an individual lodging provider in Zimmerman, Minnesota, licensed in Minnesota (FBL4413164383) and active in the NPI registry since August 2025.

NPPES Registry Identity

NPI1992680615
Entity TypeIndividualFemale
Primary Taxonomy177F00000X
Provider Legal NameSHANNON TABAKACredential: SW
Location Address12714 FREMONT AVEZimmerman, MN 55398-9406
Mailing Address6314 Cedar RdOak Park, MN 56357-8529 · (763) 732-2065
Phone(763) 732-2065
Sole ProprietorYes
Enumeration DateAugust 11, 2025
NPPES CertifiedAugust 11, 2025
✔ NPI 1992680615 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLodgingOther Service Providers
Taxonomy Code177F00000X
License✔ Licensed in MN · FBL4413164383
Definition
A public or privately owned facility providing overnight lodging to individuals traveling long distances or receiving prolonged outpatient medical services away from home.
12714 FREMONT AVE, Zimmerman, MN 55398
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shannon Tabaka's NPI number?

The NPI number for Shannon Tabaka is 1992680615. It was assigned to this individual provider in the NPPES registry on August 11, 2025.

Where is Shannon Tabaka located?

Shannon Tabaka practices at 12714 Fremont Ave, Zimmerman, MN 55398. The listed phone number is (763) 732-2065.

What is Shannon Tabaka's specialty?

The primary specialty registered for this NPI is Lodging with taxonomy code 177F00000X.

When was this NPI record last updated?

The NPPES record for Shannon Tabaka was last updated on August 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.