Provider Demographics
NPI:1245744234
Name:MICKELSON, AMANDA J (CNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:MICKELSON
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:4200 DAHLBERG DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4841
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:
Practice Address - Street 1:5715 MEMORIAL AVE N
Practice Address - Street 2:
Practice Address - City:OAK PARK HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55082-1093
Practice Address - Country:US
Practice Address - Phone:651-439-8807
Practice Address - Fax:651-439-0232
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2023-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1850563363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology