Individual
AMANDA PEDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
614 MICHIGAN AVE W, WALKER, MN 56484-2276
(218) 547-7700
(218) 547-3922
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10554
MN
363LF0000X
Family Nurse Practitioner
Primary
R140359-6
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337486600
—
MN
01
—
58G74WA
BCBS
MN
Enumeration date
09/26/2006
Last updated
03/05/2015
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