Healthcare Provider Details

I. General information

NPI: 1982014056
Provider Name (Legal Business Name): PAMELA TRIPLETT ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 10TH ST W
SAINT PAUL MN
55102-1062
US

IV. Provider business mailing address

2287 LAKERIDGE DR
WHITE BEAR LAKE MN
55110-7410
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-3696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR-141327-2
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberR-141327-2
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberR-141327-2
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberR-141327-2
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: