Provider Demographics
NPI:1558677971
Name:AMBRODAY, AUTUMN ANN (DO)
Entity type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:ANN
Last Name:AMBRODAY
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Gender:F
Credentials:DO
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Mailing Address - Street 1:40520 COUNTY HIGHWAY 34
Mailing Address - Street 2:WHITE EARTH TRIBAL MHC
Mailing Address - City:OGEMA
Mailing Address - State:MN
Mailing Address - Zip Code:56569-9612
Mailing Address - Country:US
Mailing Address - Phone:218-983-6325
Mailing Address - Fax:952-479-1443
Practice Address - Street 1:40520 COUNTY HIGHWAY 34
Practice Address - Street 2:WHITE EARTH TRIBAL MHC
Practice Address - City:OGEMA
Practice Address - State:MN
Practice Address - Zip Code:56569-9612
Practice Address - Country:US
Practice Address - Phone:218-983-6325
Practice Address - Fax:952-479-1443
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2016-11-23
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Provider Licenses
StateLicense IDTaxonomies
MN582842084P0800X
AZ62482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry