Provider Demographics
NPI:1386357788
Name:ROSENDAHL, AMBER MICHELLE
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MICHELLE
Last Name:ROSENDAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:MICHELLE
Other - Last Name:EVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9434 ROSEWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7119
Mailing Address - Country:US
Mailing Address - Phone:701-520-3344
Mailing Address - Fax:
Practice Address - Street 1:5320 W 23RD ST STE 130
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1670
Practice Address - Country:US
Practice Address - Phone:952-345-8770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9840363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology