MEDICARE: MISS JAMIE DAWN DOLIESLAGER DAT, ATC, LAT

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	390200000X	Student in an Organized Health Care Education/Training Program	119702510	MN
2	2255A2300X	Athletic Trainer	119702510

General Provider Information

NPI Number	:	1457329237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAMIE DAWN DOLIESLAGER DAT, ATC, LAT

Provider Business Mailing Address
First Line	:	260 TWILITE TER
Second Line	:
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-1625
Country	:	US
Telephone Number	:	651-491-3022
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 TWILITE TER
Second Line	:
City	:	CIRCLE PINES
State	:	MN
Zip	:	55014-1625
Country	:	US
Telephone Number	:	651-491-3022
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/26/2022

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