Healthcare Provider Details

I. General information

NPI: 1821076837
Provider Name (Legal Business Name): AMY REDLON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY KADLETZ

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 FRANCE AVE S STE W200
EDINA MN
55435
US

IV. Provider business mailing address

6405 FRANCE AVE S STE W200
EDINA MN
55435
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-9005
  • Fax: 952-924-0330
Mailing address:
  • Phone: 952-924-9005
  • Fax: 952-924-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2245
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: