Healthcare Provider Details

I. General information

NPI: 1750356952
Provider Name (Legal Business Name): KRISTI R HINNERICHS ATC, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MAIN ST
WAYNE NE
68787-1181
US

IV. Provider business mailing address

606 OAK DR
WAYNE NE
68787-1615
US

V. Phone/Fax

Practice location:
  • Phone: 402-375-7310
  • Fax:
Mailing address:
  • Phone: 402-640-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number319
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: