Jennifer A Herdebu, ATC
Individual provider Active NPI Athletic Trainer · Baldwin, ND
NPI 1760701064 · NPPES record last updated May 26, 2010
Key facts
- NPI
- 1760701064
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 2405 Elbert Ave
Baldwin, ND 58521 - Phone
- (701) 426-9324
- NPI assigned
- May 26, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
2405 Elbert Ave
Baldwin, ND 58521
Mailing address
2405 Elbert Ave
Box 116
Baldwin, ND 58521
Other providers in Baldwin, ND
All providers in Baldwin, ND · Athletic Trainer in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.