Individual
DANELLE LEIGH TIBBETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-3246
(952) 993-3010
Mailing address
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426-4702
(952) 993-3246
(952) 993-3010
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP2925
MN
363LA2200X
Adult Health Nurse Practitioner
R189644-6
MN
Other
Enumeration date
07/15/2014
Last updated
01/06/2020
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