=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417560681
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY JO ENGLE APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 11/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1930 COON RAPIDS BLVD NW
-----------------------------------------------------
City | COON RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55433-4708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-774-0011
-----------------------------------------------------
Fax | 651-774-0606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 AMES CROSSING RD STE 600
-----------------------------------------------------
City | EAGAN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55121-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-774-0011
-----------------------------------------------------
Fax | 651-774-0606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 7689
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------