Individual
SHANE CHRISTOPHER NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
5600 W GLENWOOD ST, GARDEN CITY, ID 83714
(319) 325-4177
Mailing address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-702
ID
Other
Enumeration date
09/06/2013
Last updated
02/13/2023
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