Healthcare Provider Details

I. General information

NPI: 1366437105
Provider Name (Legal Business Name): PAMELA KAY BARIBEAU MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: PAMELA KAY KIRKPATRICK/TORKELSON

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NICOLLET MALL
MINNEAPOLIS MN
55403-2530
US

IV. Provider business mailing address

333 WASHINGTON AVE N 5000
MINNEAPOLIS MN
55401-1377
US

V. Phone/Fax

Practice location:
  • Phone: 612-659-7111
  • Fax:
Mailing address:
  • Phone: 612-659-7111
  • Fax: 612-659-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0874100
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: