Healthcare Provider Details

I. General information

NPI: 1578949236
Provider Name (Legal Business Name): AMANDA KOTTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CHICAGO AVE
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

1405 N PINERIDGE CIR
SIOUX FALLS SD
57107-0939
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-6000
  • Fax:
Mailing address:
  • Phone: 605-270-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number2293967
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberR038774
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number4080
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: