IndividualActive
Andenum Waquong, DNP, PHN, FNP-C
NPI 1346083219 · Nurse Practitioner · White Bear Lake, MN
Provider details
- NPI number
- 1346083219
- Entity type
- Individual
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- DNP, PHN, FNP-C
- Sex
- Male
- Sole proprietor
- No
- License
- 2310523 (MN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Nursing Service Providers
Nursing Service Providers
Nursing Service Providers
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
2730 County Road E E
White Bear Lake, MN 55110-4963
Phone: (651) 777-6816
Approximate (ZIP-level) locationGet directions
Mailing address
5210 Porchlight Bay
Woodbury, MN 55129-3700
Registry dates
- Enumerated
- 2024-06-17
- Last updated
- 2025-06-30
- Certified
- 2025-06-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.