Provider Demographics
NPI:1407518251
Name:LANDKAMER, TAYLOR AUTUMN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:AUTUMN
Last Name:LANDKAMER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CENTER CREEK DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-3428
Mailing Address - Country:US
Mailing Address - Phone:507-238-4968
Mailing Address - Fax:507-238-1533
Practice Address - Street 1:1950 CENTER CREEK DR # 100
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-3428
Practice Address - Country:US
Practice Address - Phone:507-236-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA153956163W00000X
MN2453095163W00000X
MN8632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse