Healthcare Provider Details

I. General information

NPI: 1912381427
Provider Name (Legal Business Name): AMY LYNN EICKMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 FAWN HILL RD
CHANHASSEN MN
55317-8429
US

IV. Provider business mailing address

7339 FAWN HILL RD
CHANHASSEN MN
55317-8429
US

V. Phone/Fax

Practice location:
  • Phone: 952-465-5959
  • Fax:
Mailing address:
  • Phone: 952-465-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number244984
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: