Healthcare Provider Details

I. General information

NPI: 1508187790
Provider Name (Legal Business Name): AMY J HATCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 09/19/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425TH 7TH ST NW
CASS LAKE MN
56633
US

IV. Provider business mailing address

425 7TH ST NW
CASS LAKE MN
56633-3360
US

V. Phone/Fax

Practice location:
  • Phone: 218-335-3200
  • Fax:
Mailing address:
  • Phone: 218-335-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9344A
License Number StateWY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHSZAAWYSDX
Identifier TypeOTHER
Identifier StateWY
Identifier IssuerPTAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: