Individual
DAWN E SODERSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(630) 538-6120
Mailing address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(630) 538-6120
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209011370
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F400132098
MEDICARE PTAN (INDIVIDUAL0
IL
01
—
P01356275
MEDICARE RAILROAD PTAN (INDIVIDUAL)
IL
Enumeration date
03/18/2014
Last updated
06/26/2020
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