Individual
DR. AMANDA MARIE MACKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
4360 13TH AVE S, FARGO, ND 58103-3310
(701) 282-5880
Mailing address
4360 13TH AVE S, FARGO, ND 58103-3310
(701) 282-5880
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2935
MD
152W00000X
Optometrist
3730
MN
152W00000X
Optometrist
3852-35
WI
152W00000X
Optometrist
Primary
799
ND
Other
Enumeration date
07/14/2021
Last updated
07/18/2023
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