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General NPI Number Information
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NPI Number | 1013933381
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Entity Type | Organization
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Legal Business Name | SHAKOPEE MDEWAKANTON SIOUX COMMUNITY
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2330 SIOUX TRL NW
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City | PRIOR LAKE
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State | MN
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Zip | 55372-9077
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Country | US
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Telephone | 952-496-6150
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Fax | 952-233-4224
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Provider Business Mailing Address
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Address Line | 2330 SIOUX TRL NW
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City | PRIOR LAKE
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State | MN
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Zip | 55372-9077
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Country | US
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Telephone | 952-496-6150
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Fax | 952-233-4224
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Authorized Official
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Title or Position | HEALTH DIRECTOR
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Name | MS. MELAINE J DUNLAP
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Credential | CFNP
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Telephone | 952-496-6151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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