Provider Demographics
NPI:1003109059
Name:TSCHETTER, AMANDA JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JOY
Last Name:TSCHETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:IVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3316 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2532
Mailing Address - Country:US
Mailing Address - Phone:952-920-3808
Mailing Address - Fax:952-920-8899
Practice Address - Street 1:3316 W 66TH ST
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2532
Practice Address - Country:US
Practice Address - Phone:952-920-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454550207ND0101X
MN61224207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery