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General NPI Number Information
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NPI Number | 1053066597
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Entity Type | Individual
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Provider Name | DAVAN S FLEMING
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Gender | Female
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Dates
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Enumeration Date | 02/14/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 2121 E EMMERS DR
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City | APPLETON
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State | WI
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Zip | 54915-3802
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Country | US
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Telephone | 920-832-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 COUNTY ROAD QQ APT 14
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City | WAUPACA
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State | WI
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Zip | 54981-8620
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Country | US
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Telephone | 920-400-2265
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | WI
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