Individual
AMY FOSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12109 15TH ST NW, MOORHEAD, MN 56560-7205
(701) 367-7770
Mailing address
12109 15TH ST NW, MOORHEAD, MN 56560-7205
(701) 367-7770
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
06/15/2018
Last updated
11/18/2021
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