Provider Demographics
NPI:1679980510
Name:EDER, CARRIE (ATC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:EDER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 UNIVERSITY AVE
Mailing Address - Street 2:ATHLETIC DEPARTMENT
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4464
Mailing Address - Country:US
Mailing Address - Phone:701-580-2827
Mailing Address - Fax:
Practice Address - Street 1:1410 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4464
Practice Address - Country:US
Practice Address - Phone:701-774-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND483-122255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer