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General NPI Number Information
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NPI Number | 1295112993
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Entity Type | Individual
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Provider Name | NICOLE LICHTENWALNER MS, LAT, ATC, CEAS I
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 701 DRIVER DR
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City | HARRISONBURG
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State | VA
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Zip | 22807-1002
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Country | US
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Telephone | 540-568-8764
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Fax |
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Provider Business Mailing Address
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Address Line | 904 CAMELOT LN
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City | HARRISONBURG
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State | VA
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Zip | 22801-7721
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Country | US
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Telephone | 561-214-0799
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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 |
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