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NPI Code Detail

MEDICARE: DEEGAN GEARDING

MEDICARE: DEEGAN GEARDING
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1669171054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEEGAN GEARDING
Provider Business Mailing Address
First Line : 1113 UNIVERSITY DR N
Second Line :
City : FARGO
State : ND
Zip : 58102-5522
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 UNIVERSITY DR N
Second Line :
City : FARGO
State : ND
Zip : 58105-2502
Country : US
Telephone Number : 701-231-6378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2023
Last Update Date : 02/24/2023

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Directions to “ DEEGAN GEARDING ” Practice Location

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