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General NPI Number Information
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NPI Number | 1104142033
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Entity Type | Individual
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Provider Name | NATHAN RYAN WERREMEYER ATC
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Gender | Male
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 5270 FLAT RIVER DR
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City | PARK HILLS
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State | MO
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Zip | 63601-2224
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Country | US
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Telephone | 573-480-6479
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Fax | 573-518-2153
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Provider Business Mailing Address
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Address Line | 405 SHADE TREE LN
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City | FARMINGTON
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State | MO
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Zip | 63640-7708
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2010020243
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License Number State | MO
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