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NPI Code Detail

MEDICARE: AMY E NOSER PHD LP

MEDICARE: AMY E NOSER PHD LP
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
1103TC2200XClinical Child & Adolescent Psychologist7101MN

General Provider Information

NPI Number : 1902306640
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY E NOSER PHD LP
Provider Business Mailing Address
First Line : 717 DELAWARE ST SE RM 421
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55414-2959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2426 W BROADWAY AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-1735
Country : US
Telephone Number : 612-302-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2018
Last Update Date : 03/27/2025

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