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NPI Code Detail

MEDICARE: SHAKOPEE MDEWAKANTON SIOUX COMMUNITY

MEDICARE: SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2111N00000XChiropractor
31223G0001XGeneral Practice Dentistry
4152W00000XOptometrist
5224Z00000XOccupational Therapy Assistant
6225200000XPhysical Therapy Assistant
7363A00000XPhysician Assistant
8363LF0000XFamily Nurse Practitioner
9207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1013933381
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
Provider Business Mailing Address
First Line : 2330 SIOUX TRL NW
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-9077
Country : US
Telephone Number : 952-496-6150
Fax Number : 952-233-4224
Provider Business Practice Location Address
First Line : 2330 SIOUX TRL NW
Second Line :
City : PRIOR LAKE
State : MN
Zip : 55372-9077
Country : US
Telephone Number : 952-496-6150
Fax Number : 952-233-4224
Authorized Official
Title or Position : HEALTH DIRECTOR
Name : MS. MELAINE J DUNLAP
Credential : CFNP
Telephone Number : 952-496-6151
Provider Enumeration Date : 07/13/2006
Last Update Date : 01/31/2025

Similar Medicare Providers

1548264898 — DR. KARL M. HAEMIG DDS
Practice Location Address:
2330 SIOUX TRL NW
PRIOR LAKE, MN
55372-9077
Practice Phone: 952-496-6148
Practice Fax:
1356300297 — MRS. HELEN JANE PETERSON CNP
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PRIOR LAKE, MN
55372-9077
Practice Phone: 952-233-4214
Practice Fax:
1285650572 — DR. BRIAN RICHARD BREWER PHD, LP
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2330 SIOUX TRL NW
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55372-9077
Practice Phone: 952-496-6167
Practice Fax: 952-233-4255
1790704575 — DR. JULIE E CLOUSE DDS
Practice Location Address:
2330 SIOUX TRL NW
PRIOR LAKE, MN
55372-9077
Practice Phone: 952-496-6150
Practice Fax: 952-233-4224
1083628515 — MS. SHARON K KETTLER RDH
Practice Location Address:
2330 SIOUX TRL NW
PRIOR LAKE, MN
55372-9077
Practice Phone: 952-496-6148
Practice Fax: 952-233-4224
1821183690 — MS. CHRISTINE ANN MICHAEL RT(R)(M)
Practice Location Address:
2330 SIOUX TRL NW
PRIOR LAKE, MN
55372-9077
Practice Phone: 952-496-6150
Practice Fax: 952-233-4224

Directions to “SHAKOPEE MDEWAKANTON SIOUX COMMUNITY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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