Healthcare Provider Details

I. General information

NPI: 1659736221
Provider Name (Legal Business Name): AMANDA JEAN DAHLSENG RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JEAN IHNEN

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 ELM STREET SUITE 1200
ALEXANDRIA MN
56308
US

IV. Provider business mailing address

809 ELM STREET SUITE 1200
ALEXANDRIA MN
56308
US

V. Phone/Fax

Practice location:
  • Phone: 320-815-6124
  • Fax:
Mailing address:
  • Phone: 320-815-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR191328-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: