Healthcare Provider Details

I. General information

NPI: 1346817897
Provider Name (Legal Business Name): CHRISTIAN HONNOLD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 S 4TH ST
AMES IA
50011-1142
US

IV. Provider business mailing address

3801 EAGLE NEST DR
MINNETRISTA MN
55375-1418
US

V. Phone/Fax

Practice location:
  • Phone: 515-294-6721
  • Fax:
Mailing address:
  • Phone: 952-688-8849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: