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NPI Code Detail

MEDICARE: NICOLE ELIZABETH TRUMPOLD ATC, LAT

MEDICARE: NICOLE ELIZABETH TRUMPOLD 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
12255A2300XAthletic Trainer000947IA

General Provider Information

NPI Number : 1780047027
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ELIZABETH TRUMPOLD ATC, LAT
Provider Business Mailing Address
First Line : 650 COLTON CIR NE
Second Line : UNIT 11
City : CEDAR RAPIDS
State : IA
Zip : 52402-6760
Country : US
Telephone Number : 319-361-3490
Fax Number :
Provider Business Practice Location Address
First Line : 1220 1ST AVE NE
Second Line : EBY FIELDHOUSE
City : CEDAR RAPIDS
State : IA
Zip : 52402-5008
Country : US
Telephone Number : 319-361-3490
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2016
Last Update Date : 04/04/2016

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