Provider Demographics
NPI:1457336232
Name:HEROLD, PAULETTE M (ARNP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:M
Last Name:HEROLD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WABASHA ST S
Mailing Address - Street 2:HEALTH PARTNERS/ST PAUL CLINIC
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1805
Mailing Address - Country:US
Mailing Address - Phone:651-293-8100
Mailing Address - Fax:651-293-8106
Practice Address - Street 1:205 WABASHA ST S
Practice Address - Street 2:HEALTH PARTNERS/ST PAUL CLINIC
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1805
Practice Address - Country:US
Practice Address - Phone:651-293-8100
Practice Address - Fax:651-293-8106
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH-043411363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR 198673-8OtherMN NURSING LICENSE