Basic Information
| Provider Information | |||||||||
| NPI: | 1558677971 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMBRODAY | ||||||||
| FirstName: | AUTUMN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40520 COUNTY HIGHWAY 34 | ||||||||
| Address2: | WHITE EARTH TRIBAL MHC | ||||||||
| City: | OGEMA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565699612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189836325 | ||||||||
| FaxNumber: | 9524791443 | ||||||||
| Practice Location | |||||||||
| Address1: | 40520 COUNTY HIGHWAY 34 | ||||||||
| Address2: | WHITE EARTH TRIBAL MHC | ||||||||
| City: | OGEMA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 565699612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189836325 | ||||||||
| FaxNumber: | 9524791443 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 11/23/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 58284 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 6248 | AZ | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.