Provider Demographics
NPI:1144650250
Name:FENRICK, AMY LYNN (CSFA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:FENRICK
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:MYSZEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:902 BELL OAK DR
Mailing Address - Street 2:
Mailing Address - City:KENNEDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76060-5623
Mailing Address - Country:US
Mailing Address - Phone:608-449-0767
Mailing Address - Fax:
Practice Address - Street 1:4308 LONE OAK DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5566
Practice Address - Country:US
Practice Address - Phone:608-449-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant