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NPI Code Detail

MEDICARE: KASSONDRA JO NORDMEYER ATC

MEDICARE: KASSONDRA JO NORDMEYER ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer2255MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12255OTHERMNSTATE OF MINNESOTA BOARD OF MEDICAL PRACTICE

General Provider Information

NPI Number : 1134566136
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASSONDRA JO NORDMEYER ATC
Provider Business Mailing Address
First Line : 2211 RIVERSIDE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55454-1350
Country : US
Telephone Number : 612-330-1108
Fax Number :
Provider Business Practice Location Address
First Line : 2211 RIVERSIDE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55454-1350
Country : US
Telephone Number : 612-330-1108
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2013
Last Update Date : 12/03/2014

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