| Doctor Name: | AMY FANKHANEL |
| NPI Number: | 1780002139 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CDE |
| License Number: | RN159519-0 |
| Business Practice Address: | 1000 Coney St W Perham, MN - 565732102 |
| Business Phone Number: | 2183471199 |
| Business Fax Number: | |
| Mailing Address: | Po Box 6080, FARGO |
| State: | ND |
| Postal Code: | 581086080 |
| Phone Number: | 2183471199 |
| Fax Number: | |
| NPI Enumeration Date: | 04/02/2014 |
| NPI Last Update Date: | 04/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | RN159519-0 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |