Provider Demographics
NPI:1700410115
Name:WENDORFF, AMBER LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:WENDORFF
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:CLOOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 PINE RIDGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5101
Mailing Address - Country:US
Mailing Address - Phone:218-333-5665
Mailing Address - Fax:
Practice Address - Street 1:3201 PINE RIDGE AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5101
Practice Address - Country:US
Practice Address - Phone:218-333-5665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily