Healthcare Provider Details

I. General information

NPI: 1598891822
Provider Name (Legal Business Name): ERIN L BUENZLI MS, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E BOLDT WAY SPC 10
APPLETON WI
54911-5690
US

IV. Provider business mailing address

711 E BOLDT WAY SPC 10
APPLETON WI
54911-5690
US

V. Phone/Fax

Practice location:
  • Phone: 920-832-7190
  • Fax: 920-832-7488
Mailing address:
  • Phone: 920-832-7190
  • Fax: 920-832-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number7-039
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: