Provider Demographics
NPI:1841152055
Name:CEDERSTROM, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CEDERSTROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60301 ELBOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FINLAYSON
Mailing Address - State:MN
Mailing Address - Zip Code:55735-4294
Mailing Address - Country:US
Mailing Address - Phone:320-245-5355
Mailing Address - Fax:320-245-3140
Practice Address - Street 1:PO BOX 26
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072-0026
Practice Address - Country:US
Practice Address - Phone:320-245-5355
Practice Address - Fax:320-245-3140
Is Sole Proprietor?:No
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR518146335814172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver