MEDICARE: ANDREW ERNST ATC, CSCS

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	2379	MN

General Provider Information

NPI Number	:	1871933150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW ERNST ATC, CSCS

Provider Business Mailing Address
First Line	:	14023 CHESTNUT DR
Second Line	:	UNIT F
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1649
Country	:	US
Telephone Number	:	920-858-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	16550 W 78TH ST
Second Line	:	SUITE B
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-4315
Country	:	US
Telephone Number	:	952-873-7400
Fax Number	:

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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