Provider Demographics
NPI:1609323484
Name:ENESTVEDT, AMANDA KATE (RN CPNP-PC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATE
Last Name:ENESTVEDT
Suffix:
Gender:F
Credentials:RN CPNP-PC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:KATE
Other - Last Name:KOHLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN CPNP-PC
Mailing Address - Street 1:1521 CARLSON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2626
Mailing Address - Country:US
Mailing Address - Phone:507-532-1101
Mailing Address - Fax:507-532-1137
Practice Address - Street 1:1521 CARLSON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258
Practice Address - Country:US
Practice Address - Phone:507-532-1101
Practice Address - Fax:507-532-1137
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 4775363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics