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
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
09/15/2011
Last updated
02/21/2022
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