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General NPI Number Information
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NPI Number | 1316095342
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Entity Type | Individual
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Provider Name | MARTHA SUE VANEENENAAM-IWANICKI ATC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | FRASER HIGH SCHOOL 34270 GARFIELD
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City | FRASER
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State | MI
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Zip | 48026
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Country | US
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Telephone | 586-879-2398
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Fax | 586-415-1079
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Provider Business Mailing Address
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Address Line | 32347 OXFORD CT
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City | FRASER
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State | MI
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Zip | 48026-2346
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Country | US
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Telephone | 586-415-0561
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Fax | 586-415-1079
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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 | MI
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