Healthcare Provider Details

I. General information

NPI: 1912327297
Provider Name (Legal Business Name): AMY OLMSCHENK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR STE. 200
SAINT CLOUD MN
56303-4555
US

IV. Provider business mailing address

1406 6TH AVENUE NORTH
SAINT CLOUD MN
56303-1901
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-3157
  • Fax: 320-240-3165
Mailing address:
  • Phone: 320-251-2700
  • Fax: 320-656-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59957
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: