Healthcare Provider Details

I. General information

NPI: 1689494932
Provider Name (Legal Business Name): AMY BRYN LAMB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

4070 117H AVE SE
VALLEY CITY ND
58072-9329
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax: 701-239-3720
Mailing address:
  • Phone: 701-330-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0500X
TaxonomyHemodialysis Registered Nurse
License NumberR34288
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: