Evan Richard Mulder, DAT, LAT, OTC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

1554-39 Issued in WI

Practice address

501 N 10TH St
Manitowoc, WI 54220

Phone

(920) 682-6376

Fax

(920) 652-0115

NPI assigned

Oct 15, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549843200000",
    "number": "1356745640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 N BROADWAY",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032728",
            "telephone_number": "920-490-9046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N 10TH ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "54220",
            "telephone_number": "920-682-6376",
            "fax_number": "920-652-0115"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "155 Radio Dr",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551252619",
            "country_code": "US",
            "telephone_number": "920-831-8742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULDER",
        "first_name": "EVAN",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "DAT, LAT, OTC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-10-15",
        "last_updated": "2019-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MN",
            "license": "1554-39",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "1554-39",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Christine Moline, PHARMD
• Jennifer Monte-Last
• Joylyn Nicole Moore, RPH
• Luann Moraski, DO
• John Nicholas Moustoukas, M.D.
• Bryan J Mulheron, D.O.
• Vickie Patricia Mullins, OTR / CHT
• James T Murphy, MD
• Jayne Nagel
• Anne M Neeb, APNP

• Athletic Trainer in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.

Verify at the official NPI Registry.