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General NPI Number Information
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NPI Number | 1235647876
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Entity Type | Individual
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Provider Name | JORDAN ROBINSON LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 1160 KEPLER DR
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City | GREEN BAY
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State | WI
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Zip | 54311-8321
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Country | US
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Telephone | 920-288-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 ROSEHILL RD APT 57
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City | LITTLE CHUTE
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State | WI
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Zip | 54140-2479
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Country | US
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Telephone | 920-246-1249
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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 | 1519-39
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License Number State | WI
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