Healthcare Provider Details

I. General information

NPI: 1932543493
Provider Name (Legal Business Name): AMANDA MARIE BUZARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA GRUENHAGEN

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WAYZATA BLVD E UNIT 1151
WAYZATA MN
55391-1951
US

IV. Provider business mailing address

267 LORI LN
DELANO MN
55328-4101
US

V. Phone/Fax

Practice location:
  • Phone: 612-532-3296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP9058
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015014595
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: