Healthcare Provider Details

I. General information

NPI: 1659212124
Provider Name (Legal Business Name): MICHELLE R NEMECH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8974 SYCAMORE LN N
MAPLE GROVE MN
55369-6700
US

IV. Provider business mailing address

8974 SYCAMORE LN N
MAPLE GROVE MN
55369-6700
US

V. Phone/Fax

Practice location:
  • Phone: 612-226-4555
  • Fax:
Mailing address:
  • Phone: 612-226-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: