Provider Demographics
NPI:1194723486
Name:RONGSTAD, AMY J (FNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:RONGSTAD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:J
Other - Last Name:WELBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:824 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-1629
Mailing Address - Country:US
Mailing Address - Phone:320-269-8877
Mailing Address - Fax:320-269-8186
Practice Address - Street 1:824 N 11TH ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1629
Practice Address - Country:US
Practice Address - Phone:320-269-8877
Practice Address - Fax:320-320-8200
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR132176-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN772668600Medicaid
MN772668600Medicaid
MN500002848Medicare PIN