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Dawn E Soderstrom

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Rd E, Minnetonka, MN 55343-9664

PECOS Enrollment

This provider is enrolled in PECOS as DAWN SODERSTROM.

Based on the most recent information from CMS, provider Dawn E Soderstrom is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1124445952
Provider Type
Individual
Full Name
Soderstrom, Dawn E
Credential
NP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
3/18/2014
Last Updated
6/26/2020

Contact Information

Practice Location

9900 Bren Rd E, Minnetonka, MN 55343-9664

(630) 538-6120

Unlisted Fax

Mailing Location

9900 Bren Rd E, Minnetonka, MN 55343-9664

(630) 538-6120

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 209011370 Illinois

Provider Identifiers

ID	Description	Issuer
ID P01356275	Description Other	Issuer MEDICARE RAILROAD PTAN (INDIVIDUAL) Illinois
ID F400132098	Description Other	Issuer MEDICARE PTAN (INDIVIDUAL0 Illinois

Dawn E Soderstrom

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Hancock, Janet E

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Tedford, Abby Gail

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Camacho, Arlette Ysabelle

Malark, Claire