Provider Demographics
NPI:1609313295
Name:KJELDAHL, AMY JO (DNP, RN, APNP, OCN)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:JO
Last Name:KJELDAHL
Suffix:
Gender:F
Credentials:DNP, RN, APNP, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 EASTLAKE AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4405
Mailing Address - Country:US
Mailing Address - Phone:206-288-7222
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-4405
Practice Address - Country:US
Practice Address - Phone:608-265-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60726494163W00000X
WAAP60726497363LF0000X
WI8160-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily