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General NPI Number Information
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NPI Number | 1235747080
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Entity Type | Individual
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Provider Name | MARK ALLEN KWIKKEL
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Gender | Male
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 310 N 10TH
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City | BLAIR
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State | NE
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Zip | 68008
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Country | US
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Telephone | 402-427-2777
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 HUTTON DR
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City | DECATUR
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State | NE
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Zip | 68020-2205
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Country | US
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Telephone | 402-349-5357
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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 | 11
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License Number State | NE
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