Healthcare Provider Details

I. General information

NPI: 1154869345
Provider Name (Legal Business Name): NOELLE ELIZABETH FIELDER LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NOELLE ELIZABETH VADEN

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SE BLUE PKWY
LEES SUMMIT MO
64063-4352
US

IV. Provider business mailing address

400 SE BLUE PKWY
LEES SUMMIT MO
64063
US

V. Phone/Fax

Practice location:
  • Phone: 816-708-7500
  • Fax:
Mailing address:
  • Phone:
  • 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: