Healthcare Provider Details

I. General information

NPI: 1467020842
Provider Name (Legal Business Name): WENDI TVEDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 2ND AVE SE
CAMBRIDGE MN
55008-1602
US

IV. Provider business mailing address

145 2ND AVE SE
CAMBRIDGE MN
55008-1602
US

V. Phone/Fax

Practice location:
  • Phone: 320-496-4663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1243361
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8548
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: