Provider Demographics
NPI:1447704283
Name:TJADEN, AMANDA (MSN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TJADEN
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HARDING ST NE # 100
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-2801
Mailing Address - Country:US
Mailing Address - Phone:888-709-9344
Mailing Address - Fax:
Practice Address - Street 1:401 HARDING ST NE # 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2801
Practice Address - Country:US
Practice Address - Phone:888-709-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025674363LF0000X
MNCNP5136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily