Provider Demographics
NPI:1972597144
Name:SEVERSON, AMY L (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SEVERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44310 230TH ST
Mailing Address - Street 2:
Mailing Address - City:HENNING
Mailing Address - State:MN
Mailing Address - Zip Code:56551-9446
Mailing Address - Country:US
Mailing Address - Phone:218-583-2642
Mailing Address - Fax:
Practice Address - Street 1:401 DOUGLAS AVE
Practice Address - Street 2:TRI-COUNTY HEALTH CARE - HENNING CLINIC
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551
Practice Address - Country:US
Practice Address - Phone:218-583-2953
Practice Address - Fax:218-583-4521
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR137916-7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP82235Medicare UPIN