Individual provider
SHANNON MARIE KRUCKEBERG, RDH
CMS NPPES lists SHANNON MARIE KRUCKEBERG as an individual provider record with NPI 1003002882. The current record reports a primary practice location in CLAREMONT, MN and primary taxonomy code 124Q00000X.
Type 1 NPIs identify individual healthcare providers. How to read this profile
01
Practice locations
- Primary practice location63407 130TH AVECLAREMONT, MN 559244656
Only source-designated practice locations are shown here. Mailing addresses are not presented as practice locations.
02
Taxonomy information
124Q00000XPrimary reported taxonomy
Taxonomy codes describe provider classifications reported to NPPES. Repeated identical codes are shown once, with primary-reported status preserved. They are not licenses, certifications, quality measures, or NPIFolio specialty labels. Read the taxonomy methodology.
03
NPI record information
- NPI status
- Enumerated in NPPES
- Enumeration date
- September 14, 2007
An NPI is a federal identifier. Enumeration and lifecycle information does not establish medical-license status, current practice, disciplinary history, provider quality, or whether a provider is accepting patients.