Healthcare Provider Details

I. General information

NPI: 1609268473
Provider Name (Legal Business Name): MR. ERIC J LINNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TERRACE HTS
WINONA MN
55987-1321
US

IV. Provider business mailing address

851 E BELLEVIEW ST APT 108
WINONA MN
55987-4599
US

V. Phone/Fax

Practice location:
  • Phone: 507-995-3284
  • Fax:
Mailing address:
  • Phone: 507-995-3284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1541
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2750
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: