Northwest Missouri State University

NPI #1225310204 in Maryville, Missouri

Provider Information

NPI Number: 1225310204
Entity Type: Organization
Organization Name: Northwest Missouri State University
Primary Specialty: Family Medicine
Enumeration Date: Sep 15, 2011
Last Updated: Feb 21, 2022

Practice Location

Address: 800 UNIVERSITY DRIVE
City: Maryville
State: Missouri
ZIP Code: 64468
Phone: (660) 562-1313

Authorized Official

Name: MATTHEW CANNELLA, LAT
Title: HEAD ATHLETIC TRAINER
Phone: (660) 562-1313

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist/Technologist - Athletic Trainer — Athletic Trainer	2255A2300X
Family Medicine	207Q00000X	Primary

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