Provider Demographics
NPI:1679397665
Name:SAN MIGUEL, PAMELA MICHELLE (DNP, PMHNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MICHELLE
Last Name:SAN MIGUEL
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 BIELENBERG DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1706
Mailing Address - Country:US
Mailing Address - Phone:952-737-4507
Mailing Address - Fax:651-259-9770
Practice Address - Street 1:659 BIELENBERG DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1706
Practice Address - Country:US
Practice Address - Phone:952-737-4507
Practice Address - Fax:651-259-9770
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-14
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12157363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health