Provider Demographics
NPI:1396967881
Name:MEYER, ANNETTE R (AS)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:R
Last Name:MEYER
Suffix:
Gender:F
Credentials:AS
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:R
Other - Last Name:WINGENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AS
Mailing Address - Street 1:300 13TH AVE W
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4879
Mailing Address - Country:US
Mailing Address - Phone:701-227-7520
Mailing Address - Fax:701-227-7575
Practice Address - Street 1:300 13TH AVE W
Practice Address - Street 2:SUITE 1
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4879
Practice Address - Country:US
Practice Address - Phone:701-227-7520
Practice Address - Fax:701-227-7575
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54523Medicaid