Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Shannon Marie Wallack, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1255578068

MS. Shannon Marie Wallack, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Saint Paul, Minnesota. Qualified in 2008, 18 years ago. Practices with Regions Hospital, a 219-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
18
Licensed in
MN
In the registry since
2009
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

435 Phalen Blvd
Saint Paul, MN 55130-5302
Phone: (651) 254-8080
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2525 Chicago Ave, Minneapolis, MN 55404 — (612) 813-6121

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 517 (MN)

Record details

NPI number1255578068
Entity typeIndividual (Type 1)
GenderFemale
Credentials CRNA
Sole proprietorNo
NPI enumeratedJanuary 15, 2009
Last updated in NPPESDecember 17, 2024
Certification dateDecember 17, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Regions Hospital — 219 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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