Provider Demographics
NPI:1902174642
Name:HENTGES, AMELIA (LPN)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:HENTGES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:7 MAGNUS JOHNSON ST
Mailing Address - City:KIMBALL
Mailing Address - State:MN
Mailing Address - Zip Code:55353-0034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 MAGNUS JOHNSON STREET SOUTH
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MN
Practice Address - Zip Code:55353
Practice Address - Country:US
Practice Address - Phone:320-237-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL72444-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse