MEDICARE: DR. AMY MCNALLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD036192	DC
2	207VX0201X	Gynecologic Oncology Physician	46012	MN

General Provider Information

NPI Number	:	1649280843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY MCNALLY MD

Provider Business Mailing Address
First Line	:	345 SHERMAN ST
Second Line	:	SUITE 100-200
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2401
Country	:	US
Telephone Number	:	651-251-5500
Fax Number	:	651-251-5555

Provider Business Practice Location Address
First Line	:	310 SMITH AVE N STE 100
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2332
Country	:	US
Telephone Number	:	651-251-5500
Fax Number	:	651-251-5555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	01/19/2023

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