Active NPI
Madeline Dallman, LAT
- Athletic Trainer
- Mequon, WI
National Provider Identifier
1023487170
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2095-39
- Practice address
- 12800 N Lake Shore Dr
Mequon, WI 53097-2418 - Phone
- (262) 993-1669
- NPI assigned
- Sep 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2095-39 | WI | Primary |
Addresses
Primary practice location
12800 N Lake Shore Dr
Mequon, WI 53097-2418
Mailing address
N7529 Pawling PL
Hartland, WI 53029
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2095-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557273600000",
"number": "1023487170",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N7529 PAWLING PL",
"city": "HARTLAND",
"state": "WI",
"postal_code": "53029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12800 N LAKE SHORE DR",
"city": "MEQUON",
"state": "WI",
"postal_code": "530972418",
"telephone_number": "262-993-1669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALLMAN",
"first_name": "MADELINE",
"name_prefix": "Miss",
"credential": "LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-18",
"last_updated": "2019-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "2095-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.