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NPI Code Detail

MEDICARE: ERIN NICOLE RYSANEK MS, LAT, ATC

MEDICARE: ERIN NICOLE RYSANEK MS, LAT, 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 Trainer
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1184137044
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN NICOLE RYSANEK MS, LAT, ATC
Provider Business Mailing Address
First Line : 2570 48TH ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-1541
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2570 48TH ST
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-1541
Country : US
Telephone Number : 916-734-2145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2017
Last Update Date : 05/28/2024

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