DR. ANDENUM AMOS WAQUONG DNP, PHN, FNP-C
NPI 1346083219
Nurse Practitioner in White Bear Lake, MN

Active since June 17, 2024
2730 COUNTY ROAD E E, WHITE BEAR LAKE, MN 55110(651) 777-6816 Get Directions Write a Review

NPPES record last updated: June 30, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 30, 2025, Aug 1, 2024, Jul 15, 2024 and 1 more (4 updates tracked since 2024).

About Dr. Andenum Amos Waquong Dnp, Phn, Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ANDENUM AMOS WAQUONG DNP, PHN, FNP-C (NPI 1346083219) is an individual nurse practitioner in White Bear Lake, Minnesota, licensed in Minnesota (11769) and active in the NPI registry since June 2024.

NPPES Registry Identity

NPI1346083219
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameDR. ANDENUM AMOS WAQUONGCredential: DNP, PHN, FNP-C
Location Address2730 COUNTY ROAD E EWhite Bear Lake, MN 55110-4963
Mailing Address5210 Porchlight BayWoodbury, MN 55129-3700 · (706) 619-9010
Sole ProprietorNo
Enumeration DateJune 17, 2024
Last NPPES UpdateJune 30, 20254 updates tracked since enumeration
NPPES CertifiedJune 30, 2025
NPI 1346083219 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License Licensed in MN · 11769
Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Also ListedRegistered NurseTaxonomy 163W00000X · License 2310523 (MN), RN262014 (GA), 95283925 (CA)
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License RN262014 (GA), 11769 (MN)
2730 COUNTY ROAD E E, White Bear Lake, MN 55110

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Family)
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110
Physician Assistant
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110
Pharmacist
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110
Nurse Practitioner (Family)
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110
Physician Assistant
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110
Physician Assistant
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110
Nurse Practitioner (Family)
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110
Pharmacist
2730 COUNTY ROAD E E
WHITE BEAR LAKE, MN 55110

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1346083219, enumerated as an "individual" on June 17, 2024.

The provider is located at 2730 COUNTY ROAD E E WHITE BEAR LAKE, MN 55110 and the phone number is (651) 777-6816.

Nurse Practitioner with taxonomy code 363L00000X.