Provider Demographics
NPI:1659736221
Name:DAHLSENG, AMANDA JEAN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:DAHLSENG
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JEAN
Other - Last Name:IHNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 ELM STREET
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308
Mailing Address - Country:US
Mailing Address - Phone:320-815-6124
Mailing Address - Fax:
Practice Address - Street 1:809 ELM STREET
Practice Address - Street 2:SUITE 1200
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308
Practice Address - Country:US
Practice Address - Phone:320-815-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR191328-0163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health