Provider Demographics
NPI:1023200490
Name:PAL, JACQUELINE SUE (C-NP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:SUE
Last Name:PAL
Suffix:
Gender:F
Credentials:C-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VILLAGE CENTER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7201
Mailing Address - Country:US
Mailing Address - Phone:651-276-8346
Mailing Address - Fax:651-765-8351
Practice Address - Street 1:400 VILLAGE CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7201
Practice Address - Country:US
Practice Address - Phone:651-276-8346
Practice Address - Fax:651-765-8351
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 147242-0363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR 147242-0OtherMN STATE NURSING LICENSE