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Active NPI 1346083219 Individual Practitioner Male Practitioner

Dr. Andenum Amos Waquong , DNP, PHN, FNP-C

Nurse Practitioner • White Bear Lake, MN

Professional Overview & Biography Verified Profile Summary

Dr. Andenum Waquong, DNP, PHN, FNP-C is a registered healthcare professional specializing in Nurse Practitioner in White Bear Lake, MN. Practice services are available at 2730 COUNTY ROAD E E under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

2730 County Road E E

White Bear Lake, MN 551104963

Telephone 6517776816
Associated Practice Facility / Clinic
🏢 Grand St Paul Cvs Llc Facility NPI 1508051582

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in White Bear Lake, MN

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 30.0 Yrs
State Avg: 11.7 Yrs
Regional Practice Density
3 Specialists

Practicing in White Bear Lake, MN (2609 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-06-30
Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License MN 11769

(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.

Registered Nurse

NUCC Taxonomy Code: 163W00000X

State License MN 2310523

(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.

Registered Nurse

NUCC Taxonomy Code: 163W00000X

State License GA RN262014

(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.

Registered Nurse

NUCC Taxonomy Code: 163W00000X

State License CA 95283925

(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.

Nurse Practitioner - Family

NUCC Taxonomy Code: 363LF0000X

State License GA RN262014

Definition to come...

Nurse Practitioner - Family

NUCC Taxonomy Code: 363LF0000X

State License MN 11769

Definition to come...

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners
NPI 1285354910

Doctor of Pharmacy (Pharm.D.)

Shannon Rising , NP

Nurse Practitioner - Family

NPI 1295656510

Nurse Practitioner

Ramona Allard-Hendren , MSN

Nurse Practitioner - Family

NPI 1356335962

Master of Science in Nursing

NPI 1467087726
Robin Erickson , PA-C

Physician Assistant

NPI 1982174694

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 30, 2025

Registered Nurse (License #2310523 in MN)

📍
Updated Practice Location August 01, 2024

Registered at 2730 COUNTY ROAD E E, WHITE BEAR LAKE, MN 551104963 (Tel: 6517776816)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 01, 2024

Nurse Practitioner (License #11769 in MN)

NPI Profile Active June 17, 2024

NPI status registered as active in NPPES database

📍
Updated Practice Location June 17, 2024

Registered at 410 DEWEY ST, WISCONSIN RAPIDS, WI 544944715 (Tel: 7154236060)

📍
Updated Business Mailing Address June 17, 2024

Registered at 5210 PORCHLIGHT BAY, WOODBURY, MN 551293700 (Tel: 7066199010)

👤
Provider Name / Credentials Updated June 17, 2024

Recorded as ANDENUM WAQUONG, DNP, PHN, FNP-C

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 17, 2024

Registered Nurse (License #95283925 in CA)

🟢
Initial NPI Registration & Enumeration June 17, 2024

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1346083219
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: June 17, 2024
Last Update: June 30, 2025
Sole Proprietor: No

Mailing Address

5210 Porchlight Bay

Woodbury, MN 551293700

Phone: 7066199010

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.