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Individual

DR. ANDENUM AMOS WAQUONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DNP, PHN, FNP-C

Contact information

Practice address
2730 COUNTY ROAD E E, WHITE BEAR LAKE, MN 55110-4963
(651) 777-6816
Mailing address
5210 PORCHLIGHT BAY, WOODBURY, MN 55129-3700
(706) 619-9010

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2310523
MN
163W00000X
Registered Nurse
95283925
CA
163W00000X
Registered Nurse
RN262014
GA
363L00000X
Nurse Practitioner
Primary
11769
MN
363LF0000X
Family Nurse Practitioner
11769
MN
363LF0000X
Family Nurse Practitioner
RN262014
GA

Other

Enumeration date
06/17/2024
Last updated
06/30/2025
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