=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154098143
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BREE ARENSDORF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2021
-----------------------------------------------------
Last Update Date | 08/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 HOSPITAL DR
-----------------------------------------------------
City | MAQUOKETA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52060-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-652-2474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 911 LISA DR
-----------------------------------------------------
City | MAQUOKETA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52060-2553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | 083739
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------