MEDICARE: HANNAH NICOLE RIEGEL ATC, NREMT, CKTP

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	860-19	ND
2	390200000X	Student in an Organized Health Care Education/Training Program	717	OK

General Provider Information

NPI Number	:	1821570912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH NICOLE RIEGEL ATC, NREMT, CKTP

Provider Business Mailing Address
First Line	:	1340 ADMINISTRATION AVE
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58105
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 ADMINISTRATION AVE
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58105-5810
Country	:	US
Telephone Number	:	701-231-8011
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	10/16/2020

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