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General NPI Number Information
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NPI Number | 1306897111
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Entity Type | Individual
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Provider Name | TIFFANI LYNNE SCHAMMEL MULLINS PAC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 8225 FLYING CLOUD DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-5315
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Country | US
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Telephone | 952-944-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 3257 WOOD DUCK DR NW
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City | PRIOR LAKE
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State | MN
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Zip | 55372-3211
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Country | US
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Telephone | 952-447-2895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9320
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9320
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License Number State | MN
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