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

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1750171997

Shane Johannsen, MD is a Student in an Organized Health Care Education/Training Program in Saint Paul, Minnesota. Registered with an NPI since 2025.

In the registry since
2025
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

640 Jackson St
Saint Paul, MN 55101-2595
Phone: (651) 254-5091
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1750171997
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 10, 2025
Last updated in NPPESMay 10, 2025
Certification dateMay 10, 2025
Mailing address640 Jackson St, Saint Paul, MN 55101-2595

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