Healthcare Provider Details

I. General information

NPI: 1609313295
Provider Name (Legal Business Name): AMY JO KJELDAHL DNP, RN, APNP, OCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-4405
US

IV. Provider business mailing address

825 EASTLAKE AVE E
SEATTLE WA
98109-4405
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-1700
  • Fax:
Mailing address:
  • Phone: 206-288-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60726494
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60726497
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8160-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: