Brandon Michael Pennings, ATC, LAT
Individual provider Active NPI Athletic Trainer · Denmark, WI
NPI 1215322011 · NPPES record last updated Mar 30, 2015
Key facts
- NPI
- 1215322011
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2000019385 (WI)
- Practice address
- 224 Wisconsin Ave
Denmark, WI 54208-9737 - Phone
- (920) 713-0702
- NPI assigned
- Mar 30, 2015
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000019385 | WI | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000019385 | WI | Yes |
Addresses
Primary practice location
224 Wisconsin Ave
Denmark, WI 54208-9737
Mailing address
224 Wisconsin Ave
Denmark, WI 54208-9737
Phone (920) 713-0702
Other providers in Denmark, WI
- Kohnle Investments LLC
- Beverly Kohnle
- Mark Cooke Lyman
- Grace Nys
- George Thomas O'Hearn
- Brandon Roy Rentmeester
- School District of Denmark
- Kelly Schuessler
- Molly B Sperber
- Amy Lynn Steier-Johnson
All providers in Denmark, WI · Athletic Trainer in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.