Healthcare Provider Details

I. General information

NPI: 1609323484
Provider Name (Legal Business Name): AMANDA KATE ENESTVEDT RN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA KATE KOHLS RN CPNP-PC

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 CARLSON ST
MARSHALL MN
56258
US

IV. Provider business mailing address

1521 CARLSON ST
MARSHALL MN
56258-2626
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-1101
  • Fax: 507-532-1137
Mailing address:
  • Phone: 507-532-1101
  • Fax: 507-532-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP 4775
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: