Provider Demographics
NPI:1215679287
Name:MUMM, ABRIELLE ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ABRIELLE
Middle Name:ANNE
Last Name:MUMM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:900 LONG LAKE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6414
Mailing Address - Country:US
Mailing Address - Phone:612-213-2370
Mailing Address - Fax:612-524-5571
Practice Address - Street 1:900 LONG LAKE RD STE 150
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6414
Practice Address - Country:US
Practice Address - Phone:612-213-2370
Practice Address - Fax:612-524-5571
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2024-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN14305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant