MEDICARE: COLLEEN A SCHAEFFEL PAC

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
1	363A00000X	Physician Assistant	10066	MN

General Provider Information

NPI Number	:	1104854678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN A SCHAEFFEL PAC

Provider Business Mailing Address
First Line	:	12917 FAIRFIELD RD W
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305-1106
Country	:	US
Telephone Number	:	952-457-8318
Fax Number	:

Provider Business Practice Location Address
First Line	:	4729 COUNTY ROAD 101
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55345-2634
Country	:	US
Telephone Number	:	952-974-3200
Fax Number	:	952-974-3201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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Directions to “ COLLEEN A SCHAEFFEL PAC” Practice Location

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