Healthcare Provider Details

I. General information

NPI: 1003109059
Provider Name (Legal Business Name): AMANDA JOY TSCHETTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JOY IVERSON

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3316 W 66TH ST
EDINA MN
55435-2532
US

IV. Provider business mailing address

3316 W 66TH ST
EDINA MN
55435-2532
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-3808
  • Fax:
Mailing address:
  • Phone: 952-920-3808
  • Fax: 952-920-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD454550
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number61224
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: