Holly Jo Ettenhofer
Individual provider Active NPI Athletic Trainer · Wells, MI
NPI 1770978710 · NPPES record last updated Apr 6, 2015
Key facts
- NPI
- 1770978710
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 6320 S 6TH St
Wells, MI 49894-9701 - Phone
- (906) 553-1610
- NPI assigned
- Apr 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
6320 S 6TH St
Wells, MI 49894-9701
Mailing address
6320 South 6TH Street
Wells, MI 49894
Phone (906) 553-1610
Other providers in Wells, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 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.