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Organization
NORTHWEST MISSOURI STATE UNIVERSITY
Active
Organization
NORTHWEST MISSOURI STATE UNIVERSITY
Active
Other names
Northwest Missouri State
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW CANNELLA LAT (HEAD ATHLETIC TRAINER)
(660) 562-1313
Entity
Organization
Contact information
Practice address
800 UNIVERSITY DRIVE, MARYVILLE, MO 64468
(660) 562-1313
Mailing address
800 UNIVERSITY DRIVE, MARYVILLE, MO 64468
(660) 562-1313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
2255A2300X
Athletic Trainer
—
NULL
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
09/15/2011
Last updated
02/21/2022
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