MEDICARE: VENESSA NERSTEN 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		CO

General Provider Information

NPI Number	:	1740676303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENESSA NERSTEN ATC

Provider Business Mailing Address
First Line	:	800 W 1ST ST APT 5A
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-8993
Country	:	US
Telephone Number	:	360-391-4261
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 PHYSICAL EDUCATION BUILDING
Second Line	:
City	:	CHENEY
State	:	WA
Zip	:	99004-2476
Country	:	US
Telephone Number	:	509-280-2504
Fax Number	:

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	01/15/2019

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