MEDICARE: MS. GABRIELLE ADELE SHNURMAN 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
1	2255A2300X	Athletic Trainer	001019	IA

General Provider Information

NPI Number	:	1366887093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GABRIELLE ADELE SHNURMAN ATC

Provider Business Mailing Address
First Line	:	6000 UNIVERSITY AVE STE 250
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8206
Country	:	US
Telephone Number	:	515-221-1102
Fax Number	:	515-221-1272

Provider Business Practice Location Address
First Line	:	6000 UNIVERSITY AVE STE 250
Second Line	:
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-8206
Country	:	US
Telephone Number	:	515-221-1102
Fax Number	:	515-221-1272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/08/2013

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