Provider Demographics
NPI:1942465851
Name:SUDA, AMY LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:SUDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2313
Mailing Address - Country:US
Mailing Address - Phone:701-379-0140
Mailing Address - Fax:701-895-5508
Practice Address - Street 1:15 E 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2313
Practice Address - Country:US
Practice Address - Phone:701-379-0140
Practice Address - Fax:701-895-5508
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19958Medicaid
ND19958Medicaid