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Individual

JENNIFIER R JOHNSRUD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
2400 32ND AVE S, SPORTS MEDICINE, FARGO, ND 58122-0001
(701) 234-7911
Mailing address
3026 34TH ST S, MOORHEAD, MN 56560-6937
(701) 388-3956

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1899
MN
2255A2300X
Athletic Trainer
Primary
310-06
ND

Other

Enumeration date
11/01/2006
Last updated
07/08/2007
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