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NPI Code Detail

MEDICARE: JESSICA ROSE BRESTEL MS, ATC

MEDICARE:   JESSICA ROSE BRESTEL  MS, 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

General Provider Information

NPI Number : 1952827297
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA ROSE BRESTEL MS, ATC
Provider Business Mailing Address
First Line : 1920 OAKDALE AVE APT 209
Second Line :
City : WEST ST PAUL
State : MN
Zip : 55118-4636
Country : US
Telephone Number : 402-570-8136
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 : 612-330-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2017
Last Update Date : 08/18/2017

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Directions to “ JESSICA ROSE BRESTEL MS, ATC” Practice Location

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