Healthcare Provider Details

I. General information

NPI: 1851758130
Provider Name (Legal Business Name): JOSEPH HANEL LAT/ ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W EDISON AVE 110
APPLETON WI
54915-1367
US

IV. Provider business mailing address

N1818 SWANEE CIR
GREENVILLE WI
54942-8803
US

V. Phone/Fax

Practice location:
  • Phone: 920-209-1662
  • Fax:
Mailing address:
  • Phone: 920-809-7886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1776
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: