Duffy David Eberhardt
Individual provider Active NPI Athletic Trainer · Ixonia, WI
NPI 1669961124 · NPPES record last updated May 9, 2018
Key facts
- NPI
- 1669961124
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- N7936 Woody LN
Ixonia, WI 53036-9479 - Phone
- (262) 510-8130
- NPI assigned
- May 9, 2018
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | |||
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
N7936 Woody LN
Ixonia, WI 53036-9479
Mailing address
N7936 Woody LN
Ixonia, WI 53036-9479
Phone (262) 510-8130
Other providers in Ixonia, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2018. 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.