MEDICARE: ANDREW ERIC NEWELL

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	000696	IA

General Provider Information

NPI Number	:	1447521075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW ERIC NEWELL

Provider Business Mailing Address
First Line	:	1 TRITON CIR
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TRITON CIR
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5730
Country	:	US
Telephone Number	:	515-574-1349
Fax Number	:

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	05/15/2013

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