MEDICARE: DAWNA LYNN GILBERT 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	100194	MO

General Provider Information

NPI Number	:	1427003656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWNA LYNN GILBERT ATC

Provider Business Mailing Address
First Line	:	105 N ROGERS ST
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-4014
Country	:	US
Telephone Number	:	816-254-4728
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 S M-291 HWY
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057-1201
Country	:	US
Telephone Number	:	816-373-9328
Fax Number	:	816-373-9207

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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