Healthcare Provider Details

I. General information

NPI: 1922971639
Provider Name (Legal Business Name): AMAJENAE POWELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14551 COUNTY ROAD 11 STE 100
BURNSVILLE MN
55337-4799
US

IV. Provider business mailing address

14551 COUNTY ROAD 11 STE 100
BURNSVILLE MN
55337-4799
US

V. Phone/Fax

Practice location:
  • Phone: 952-841-2345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13176
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: