Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R1462456 | MN |
NPI | 1013163922 |
---|---|
Provider Name | Brenda K Amundson |
First Address | Bemidji, MN 56601-2600 |
Second Address | Bemidji, MN 56601-2600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 10/12/2013 |