MEDICARE: MR. JAMES MATTHEW NERRIE ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1033252598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MATTHEW NERRIE ATC

Provider Business Mailing Address
First Line	:	6193 NE 185TH ST
Second Line	:
City	:	KENMORE
State	:	WA
Zip	:	98028-8908
Country	:	US
Telephone Number	:	206-618-8281
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 MONTLAKE BLVD NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98195-3005
Country	:	US
Telephone Number	:	206-618-8281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	04/22/2020

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