Individual provider · NPI-1

Scott Corneliussen, ATC

Specialist/Technologist, Athletic Trainer · Fargo, ND

NPI number1609228048
StatusActive
Last updated in NPPESJul 11, 2016

Details

NPI
1609228048
Entity type
Individual (NPI-1)
Name
Scott Corneliussen
Credential
ATC
Sex
Male
Sole proprietor
No
Enumeration date
Jul 11, 2016
Last updated
Jul 11, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer–MNYes

Practice location

5200 21st Ave S
Apt. #201
Fargo, ND 58103-7787

Phone 701-361-4730

Mailing address

5200 21st Ave S
Apt. #201
Fargo, ND 58103-7787

Phone 701-361-4730

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Specialist/Technologist, Athletic Trainer providers in Fargo, ND