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General NPI Number Information
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NPI Number | 1235352006
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Entity Type | Individual
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Provider Name | NATHAN DANIEL NEWMAN ATC
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1450 ALTA VISTA ST BOX 212
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City | DUBUQUE
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State | IA
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Zip | 52001-4327
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Country | US
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Telephone | 563-588-7019
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 LOCUST ST # 2
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City | DUBUQUE
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State | IA
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Zip | 52001-4702
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Country | US
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Telephone | 563-581-4494
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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 | 00527
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License Number State | IA
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