Provider Demographics
NPI:1730270745
Name:PAGLIUCA, TRACY GALLAGHER (RN, CNP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:GALLAGHER
Last Name:PAGLIUCA
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:TRACY
Other - Last Name:GALLAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:DULUTH CLINIC
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-3443
Mailing Address - Fax:218-720-4633
Practice Address - Street 1:400 E 3RD ST
Practice Address - Street 2:DULUTH CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-3443
Practice Address - Fax:218-720-4633
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR125496-5363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1730270745Medicaid
MN500004508Medicare PIN
S93387Medicare UPIN
MNS93387Medicare UPIN