1720151913 NPI number — AMBER MARIE DUEY LSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720151913 NPI number — AMBER MARIE DUEY LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUEY
Provider First Name:
AMBER
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720151913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
524 4TH AVE NE
Provider Second Line Business Mailing Address:
UNIT 19
Provider Business Mailing Address City Name:
DEVILS LAKE
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58301-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-662-7050
Provider Business Mailing Address Fax Number:
701-662-3360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
524 4TH AVE NE
Provider Second Line Business Practice Location Address:
UNIT 19
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-2490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-7050
Provider Business Practice Location Address Fax Number:
701-662-3360
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  3842 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X , with the licence number: 3842 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 3842 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 79310 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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