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General NPI Number Information
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NPI Number | 1306903240
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Entity Type | Individual
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Provider Name | CRYSTAL LEA LANNING ATC
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 410 S 3RD ST
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City | RIVER FALLS
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State | WI
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Zip | 54022-5010
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Country | US
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Telephone | 715-425-0711
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 MANOR LN
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City | HASTINGS
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State | MN
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Zip | 55033-3319
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Country | US
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Telephone |
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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 | 1800
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 673-039
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License Number State | WI
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