Healthcare Provider Details

I. General information

NPI: 1730270745
Provider Name (Legal Business Name): TRACY GALLAGHER PAGLIUCA RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY TRACY GALLAGHER CNP

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 3RD ST DULUTH CLINIC
DULUTH MN
55805-1951
US

IV. Provider business mailing address

400 E 3RD ST DULUTH CLINIC
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3443
  • Fax: 218-720-4633
Mailing address:
  • Phone: 218-786-3443
  • Fax: 218-720-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR125496-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: