MEDICARE: ANASTASIA NEMEC 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	0401	SD

General Provider Information

NPI Number	:	1801366760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANASTASIA NEMEC ATC

Provider Business Mailing Address
First Line	:	323 ZIEBACH ST
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-2293
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 UNIVERSITY ST
Second Line	:
City	:	SPEARFISH
State	:	SD
Zip	:	57799-8840
Country	:	US
Telephone Number	:	605-642-6622
Fax Number	:

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

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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