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

Shannon Tabaka, SW

Individual provider Lodging Provider · NPI 1992680615

Shannon Tabaka, SW is a Lodging Provider in Zimmerman, Minnesota. Practices as a sole proprietor. Licensed in Minnesota.

Licensed in
MN
In the registry since
2025

Practice location Address checks out

12714 Fremont Ave
Zimmerman, MN 55398-9406
Phone: (763) 732-2065
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Lodging Provider (primary) Taxonomy 177F00000X · Licence FBL4413164383 (MN)

Record details

NPI number1992680615
Entity typeIndividual (Type 1)
GenderFemale
Credentials SW
Sole proprietorYes
NPI enumeratedAugust 11, 2025
Last updated in NPPESAugust 11, 2025
Certification dateAugust 11, 2025