Healthcare Provider Details

I. General information

NPI: 1447704283
Provider Name (Legal Business Name): AMANDA TJADEN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HARDING ST NE # 100
MINNEAPOLIS MN
55413-2801
US

IV. Provider business mailing address

401 HARDING ST NE # 100
MINNEAPOLIS MN
55413-2801
US

V. Phone/Fax

Practice location:
  • Phone: 888-709-9344
  • Fax:
Mailing address:
  • Phone: 888-709-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016025674
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP5136
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: