Provider Demographics
NPI:1538138722
Name:CHRISTOPHERSON, SHANNON M (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:M
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:8301 GOLDEN VALLEY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427
Mailing Address - Country:US
Mailing Address - Phone:763-233-5755
Mailing Address - Fax:763-233-5782
Practice Address - Street 1:9825 HOSPITAL DR, STE 203
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-233-5755
Practice Address - Fax:763-233-5782
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2025-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN10098363A00000X, 363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical