Provider Demographics
NPI:1215008156
Name:MCNALLAN, PAMELA KAYE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAYE
Last Name:MCNALLAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CARLSON PKWY
Mailing Address - Street 2:#101
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5333
Mailing Address - Country:US
Mailing Address - Phone:608-385-8354
Mailing Address - Fax:
Practice Address - Street 1:12450 WAYZATA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1978
Practice Address - Country:US
Practice Address - Phone:952-546-6866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant