Provider Demographics
NPI:1265612204
Name:MEIDINGER, AMY LYNN (PHD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:MEIDINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MAIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8233
Mailing Address - Country:US
Mailing Address - Phone:701-297-7588
Mailing Address - Fax:701-364-2256
Practice Address - Street 1:1220 MAIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8233
Practice Address - Country:US
Practice Address - Phone:701-297-7588
Practice Address - Fax:701-364-2256
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist