Provider Demographics
NPI:1336134626
Name:ROLFZEN, AMY JO (CNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:JO
Last Name:ROLFZEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:KLUEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:900 NICOLLET MALL
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2530
Mailing Address - Country:US
Mailing Address - Phone:651-224-2155
Mailing Address - Fax:
Practice Address - Street 1:1040 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3001
Practice Address - Country:US
Practice Address - Phone:651-224-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1351279363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500003089Medicare UPIN