Healthcare Provider Details

I. General information

NPI: 1265948434
Provider Name (Legal Business Name): NORIAN EDWARDS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2017
Last Update Date: 12/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAGLE CREST DRIVE.
RANGELY CO
81648
US

IV. Provider business mailing address

225 EAGLE CREST DRIVE.
RANGELY CO
81648
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-4205
  • Fax:
Mailing address:
  • Phone: 970-675-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0001275
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: