Individual
MOLLY NORDMEYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1275 N CONVENT ST, SUITE 3, BOURBONNAIS, IL 60914-8210
(815) 936-1855
Mailing address
19817 CENTER ST, MOKENA, IL 60448-1606
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096.003186
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096.003186
OUTREACH ATHLETIC TRAINER
IL
01
—
2000007745
OUT REACH ATHLETIC TRAINER- BOC
IL
Enumeration date
03/18/2015
Last updated
03/18/2015
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