Provider Demographics
NPI:1952111015
Name:RASTEDT, AMBER ANNICE (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:ANNICE
Last Name:RASTEDT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50008 535TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENAHGA
Mailing Address - State:MN
Mailing Address - Zip Code:56464-2259
Mailing Address - Country:US
Mailing Address - Phone:218-218-3710
Mailing Address - Fax:
Practice Address - Street 1:421 11TH ST NW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1044
Practice Address - Country:US
Practice Address - Phone:218-631-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1850673163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse