Provider Demographics
NPI:1215344825
Name:TIBBETTS, DANELLE LEIGH (RN, CNP)
Entity type:Individual
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First Name:DANELLE
Middle Name:LEIGH
Last Name:TIBBETTS
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Gender:F
Credentials:RN, CNP
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Mailing Address - Street 1:6500 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4702
Mailing Address - Country:US
Mailing Address - Phone:952-993-3246
Mailing Address - Fax:952-993-3010
Practice Address - Street 1:6500 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4702
Practice Address - Country:US
Practice Address - Phone:952-993-3246
Practice Address - Fax:952-993-3010
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2020-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR189644-6363LA2200X
MNCNP2925363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health