Individual
AMANDA J MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
5715 MEMORIAL AVE N, OAK PARK HEIGHTS, MN 55082-1093
(651) 439-8807
(651) 439-0232
Mailing address
4200 DAHLBERG DR STE 300, GOLDEN VALLEY, MN 55422-4841
(952) 512-5600
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
1850563
MN
Other
Enumeration date
11/29/2017
Last updated
11/20/2023
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